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General NPI Number Information
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NPI Number | 1104133792
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Entity Type | Organization
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Legal Business Name | DR HONG'S MEDICAL PC
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Dates
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Enumeration Date | 09/03/2010
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Last Update Date | 11/19/2010
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Provider Practice Location Address
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Address Line | 14205 ROOSEVELT AVE STE 109
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City | FLUSHING
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State | NY
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Zip | 11354-6005
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Country | US
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Telephone | 718-886-5252
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Fax | 718-539-0677
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Provider Business Mailing Address
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Address Line | 14205 ROOSEVELT AVE STE 109
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City | FLUSHING
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State | NY
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Zip | 11354-6005
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Country | US
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Telephone | 718-886-5252
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Fax | 718-539-0677
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Authorized Official
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Title or Position | OWNER
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Name | DR. JAE KWANG HONG
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Credential | MD
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Telephone | 718-886-5252
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM2500X
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Taxonomy Name | Medical Specialty Clinic/Center
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License Number | 200108
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License Number State | NY
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