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General NPI Number Information
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NPI Number | 1881465656
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Entity Type | Individual
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Provider Name | SE JONG HONG
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Gender | Male
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Dates
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Enumeration Date | 01/11/2024
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Last Update Date | 02/08/2024
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Provider Practice Location Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245; BLDG 3031
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City | APO
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State | AP
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Zip | 96271-5245
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Country | US
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Telephone | 315-737-2764
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Fax |
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Provider Business Mailing Address
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Address Line | BRIAN D. ALLGOOD ARMY COMMUNITY HOSPITAL (BDAACH) UNIT #15245; BLDG 3031
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City | APO
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State | AP
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Zip | 96271
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1213772
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License Number State | NULL
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