Healthcare Provider Details

I. General information

NPI: 1679214266
Provider Name (Legal Business Name): PHILIP KYUNG WOO HONG BS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KYUNG WOO HONG

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 SW ARCHER RD
GAINESVILLE FL
32610-3003
US

IV. Provider business mailing address

PO BOX 100109
GAINESVILLE FL
32610-0109
US

V. Phone/Fax

Practice location:
  • Phone: 714-331-2856
  • Fax:
Mailing address:
  • Phone: 352-265-0761
  • Fax: 352-265-1060

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: