Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 204C00000X | Sports Medicine Doctor | 20A8140 | CA |
N | 204D00000X | Neuromusculoskeletal Medicine (NMM) | 20A8140 | CA |
NPI | 1912018219 |
---|---|
Provider Name | Dr. Joseph Sungwook Hong |
First Address | Chula Vista, CA 91910-5696 |
Second Address | San Diego, CA 92121-6310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2006 |
Last Update Date | 22/03/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
11542097 | CAQH (01) | |
20A8140 | STATE LICENSE (01) | CA |
BH8147046 | DEA (01) | |
H95530 | (02) | CA |