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General NPI Number Information
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NPI Number | 1962586883
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Entity Type | Organization
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Legal Business Name | STEPHAN T. HONDA, MD INC
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Dates
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Enumeration Date | 10/25/2006
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Last Update Date | 09/27/2019
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Provider Practice Location Address
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Address Line | 2301 W EL SEGUNDO BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-3315
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Country | US
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Telephone | 323-757-2118
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Fax |
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Provider Business Mailing Address
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Address Line | 2301 W EL SEGUNDO BLVD
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City | HAWTHORNE
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State | CA
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Zip | 90250-3315
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Country | US
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Telephone | 323-757-2118
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Fax |
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. STEPHAN T HONDA I
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Credential | M.D.
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Telephone | 323-757-2118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QU0200X
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Taxonomy Name | Urgent Care Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QH0100X
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Taxonomy Name | Health Service Clinic/Center
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License Number | G069860
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License Number State | CA
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