Healthcare Provider Details

I. General information

NPI: 1578657391
Provider Name (Legal Business Name): KYUNG HWAN HONG O.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

405 HARTFORD RD
NEW BRITAIN CT
06053-1507
US

IV. Provider business mailing address

405 HARTFORD RD
NEW BRITAIN CT
06053-1507
US

V. Phone/Fax

Practice location:
  • Phone: 860-893-7016
  • Fax: 860-893-7017
Mailing address:
  • Phone: 860-893-7016
  • Fax: 860-893-7017

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code152W00000X
TaxonomyOptometrist
License Number002654
License Number StateCT
# 2
Primary TaxonomyN
Taxonomy Code152WC0802X
TaxonomyCorneal and Contact Management Optometrist
License Number4186
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: