Healthcare Provider Details

I. General information

NPI: 1306295225
Provider Name (Legal Business Name): MICHAEL HONG JR. M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2016
Last Update Date: 08/19/2022
Certification Date: 08/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 LUSITANA ST STE 1007A
HONOLULU HI
96813-2461
US

IV. Provider business mailing address

1380 LUSITANA ST STE 1007A
HONOLULU HI
96813-2461
US

V. Phone/Fax

Practice location:
  • Phone: 716-725-3116
  • Fax:
Mailing address:
  • Phone: 716-725-3116
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License NumberMD-22531
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: