MEDICARE: JAE Y HONG DDS

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	DE8227	WA

General Provider Information

NPI Number	:	1538257308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAE Y HONG DDS

Provider Business Mailing Address
First Line	:	1409 MADRONA AVE
Second Line	:
City	:	EVERETT
State	:	WA
Zip	:	98203-1727
Country	:	US
Telephone Number	:	206-234-4044
Fax Number	:

Provider Business Practice Location Address
First Line	:	5929 EVERGREEN WAY
Second Line	:	# 300
City	:	EVERETT
State	:	WA
Zip	:	98203-6031
Country	:	US
Telephone Number	:	425-356-3000
Fax Number	:

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

Provider Enumeration Date	:	10/10/2006
Last Update Date	:	07/08/2007

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Directions to “ JAE Y HONG DDS” Practice Location

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