Healthcare Provider Details

I. General information

NPI: 1578099206
Provider Name (Legal Business Name): JONATHAN TONG SUNG HOH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/01/2017
Last Update Date: 08/06/2020
Certification Date: 08/06/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4461 STATE ROUTE 159 STE A
CHILLICOTHEE OH
45601-6000
US

IV. Provider business mailing address

4461 STATE ROUTE 159 STE A
CHILLICOTHEE OH
45601-6000
US

V. Phone/Fax

Practice location:
  • Phone: 740-779-4900
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number34.014659
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: