Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2251G0304X | Physical Therapist - Geriatrics | 43477 | CA |
NPI | 1255797734 |
---|---|
Provider Name | Jaime Hong |
First Address | Fullerton, CA 92833-1224 |
Second Address | Monterey Park, CA 91754-1203 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/01/2016 |
Last Update Date | 13/01/2016 |