Healthcare Provider Details

I. General information

NPI: 1033186085
Provider Name (Legal Business Name): JACK J. HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/08/2006
Last Update Date: 09/29/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22 S GREENE ST GUDELSKY BASEMENT
BALTIMORE MD
21201-1544
US

IV. Provider business mailing address

PO BOX 64620
BALTIMORE MD
21264-4620
US

V. Phone/Fax

Practice location:
  • Phone: 410-706-5660
  • Fax:
Mailing address:
  • Phone: 410-706-5660
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberD0040989
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: