Healthcare Provider Details

I. General information

NPI: 1124605548
Provider Name (Legal Business Name): DANIEL HONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 08/05/2024
Certification Date: 05/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

660 S EUCLID AVE # 1184
SAINT LOUIS MO
63110-1010
US

IV. Provider business mailing address

660 S EUCLID AVE # 1184
SAINT LOUIS MO
63110-1010
US

V. Phone/Fax

Practice location:
  • Phone:
  • Fax:
Mailing address:
  • Phone: 314-935-5949
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2085R0001X
TaxonomyRadiation Oncology Physician
License Number2022017915
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: