MEDICARE: THERESA ANNA MARIA HONG D.O.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	204D00000X	Neuromusculoskeletal Medicine & OMM Physician	20A54160	CA

General Provider Information

NPI Number	:	1174733984
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THERESA ANNA MARIA HONG D.O.

Provider Business Mailing Address
First Line	:	2041 POLK ST STE E
Second Line	:	SAN FRANCISCO
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2549
Country	:	US
Telephone Number	:	415-673-2771
Fax Number	:	415-674-1408

Provider Business Practice Location Address
First Line	:	2041 POLK ST STE E
Second Line	:	SAN FRANCISCO
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-2549
Country	:	US
Telephone Number	:	415-673-2771
Fax Number	:	415-674-1408

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2007
Last Update Date	:	07/08/2007

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