Healthcare Provider Details

I. General information

NPI: 1336123827
Provider Name (Legal Business Name): HYUN JOONG HONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 02/09/2023
Certification Date: 02/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

21616 76TH AVE W STE 102
EDMONDS WA
98026-7512
US

IV. Provider business mailing address

PO BOX 827
BELLEVUE WA
98009-0827
US

V. Phone/Fax

Practice location:
  • Phone: 425-774-1538
  • Fax: 425-744-1527
Mailing address:
  • Phone: 425-774-1538
  • Fax: 425-774-5171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD00040216
License Number StateWA
# 2
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD00040216
License Number StateWA
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD000040216
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: