Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207YX0007X | Plastic Surgeon (Head & Neck) | A34007 | CA |
NPI | 1063613941 |
---|---|
Provider Name | Kwang Shin Hong |
First Address | Pasadena, CA 91188-0001 |
Second Address | Bakersfield, CA 93301-1407 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 30/05/2007 |
Last Update Date | 30/11/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00A340070 | (05) | CA |
F22614 | (02) |