Healthcare Provider Details

I. General information

NPI: 1801224480
Provider Name (Legal Business Name): SANG KWON HONG L.AC.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 04/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4010 FONT HILL DR
ELLICOTT CITY MD
21042-5616
US

IV. Provider business mailing address

4010 FONT HILL DR
ELLICOTT CITY MD
21042-5616
US

V. Phone/Fax

Practice location:
  • Phone: 443-812-0857
  • Fax:
Mailing address:
  • Phone: 443-812-0857
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberU02420
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License NumberM04274
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code225700000X
TaxonomyMassage Therapist
License Number0019008551
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: