Healthcare Provider Details

I. General information

NPI: 1639112485
Provider Name (Legal Business Name): RAI BOK HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

138 YPAO RD BOX 6402
TAMUNING GU
96913-3905
US

IV. Provider business mailing address

138 YPAO RD BOX 6402
TAMUNING GU
96913-3905
US

V. Phone/Fax

Practice location:
  • Phone: 671-646-6822
  • Fax: 671-646-3857
Mailing address:
  • Phone: 671-646-6822
  • Fax: 671-646-3857

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License Number558
License Number StateGU

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: