MEDICARE: STEPHANIE HONG

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	2255A2300X	Athletic Trainer	2000001728	CA
2	2251S0007X	Sports Physical Therapist	39134	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	39134	OTHER	CA	PT LICENSE

General Provider Information

NPI Number	:	1922417716
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	STEPHANIE HONG

Provider Business Mailing Address
First Line	:	24292 PALO VERDE DR
Second Line	:
City	:	VALENCIA
State	:	CA
Zip	:	91354-1554
Country	:	US
Telephone Number	:	661-733-1416
Fax Number	:

Provider Business Practice Location Address
First Line	:	5311 DERRY AVE STE I
Second Line	:
City	:	AGOURA HILLS
State	:	CA
Zip	:	91301-5069
Country	:	US
Telephone Number	:	818-707-2523
Fax Number	:

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

Provider Enumeration Date	:	08/06/2014
Last Update Date	:	03/11/2020

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Directions to “ STEPHANIE HONG ” Practice Location

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