Healthcare Provider Details

I. General information

NPI: 1801185558
Provider Name (Legal Business Name): JI SU HONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: JI S HONG M.D.

II. Dates (important events)

Enumeration Date: 04/04/2011
Last Update Date: 10/13/2023
Certification Date: 10/13/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3901 GREENSPRING AVE
BALTIMORE MD
21211-1353
US

IV. Provider business mailing address

3901 GREENSPRING AVENUE
BALTIMORE MD
21211
US

V. Phone/Fax

Practice location:
  • Phone: 443-923-7630
  • Fax:
Mailing address:
  • Phone: 443-923-7630
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License NumberD0083575
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: