Healthcare Provider Details

I. General information

NPI: 1437412558
Provider Name (Legal Business Name): HYUNOUK HONG DO, MPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: HYUN HONG

II. Dates (important events)

Enumeration Date: 06/22/2012
Last Update Date: 06/07/2021
Certification Date: 06/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

25 S RIVER RD
BEDFORD NH
03110-6708
US

IV. Provider business mailing address

25 S RIVER RD
BEDFORD NH
03110-6708
US

V. Phone/Fax

Practice location:
  • Phone: 603-695-2572
  • Fax:
Mailing address:
  • Phone: 603-629-1793
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number17366
License Number StateNH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: