Provider Demographics
NPI:1033237573
Name:HONG, TAE YOUNG (DC)
Entity Type:Individual
Prefix:
First Name:TAE
Middle Name:YOUNG
Last Name:HONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4167 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10033-3730
Mailing Address - Country:US
Mailing Address - Phone:212-543-2233
Mailing Address - Fax:212-543-1524
Practice Address - Street 1:4167 BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10033-3730
Practice Address - Country:US
Practice Address - Phone:212-543-2233
Practice Address - Fax:212-543-1524
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY8755111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYX2B591Medicare UPIN