Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 122300000X | Dentist | 12012568A | IN |
NPI | 1003269614 |
---|---|
Provider Name | Dr. Jeong Hwa Hong |
First Address | Indianapolis, IN 46204-1257 |
Second Address | Indianapolis, IN 46202-5211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/07/2016 |
Last Update Date | 19/07/2016 |