Provider Demographics
NPI:1093134181
Name:HONG-DECAPIO, MINJUNG
Entity Type:Individual
Prefix:
First Name:MINJUNG
Middle Name:
Last Name:HONG-DECAPIO
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MINJUNG
Other - Middle Name:
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13115 WHITTINGTON DR APT 7308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77077-2689
Mailing Address - Country:US
Mailing Address - Phone:347-906-0339
Mailing Address - Fax:
Practice Address - Street 1:1213 HERMANN DR STE 770
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77004-7031
Practice Address - Country:US
Practice Address - Phone:713-807-8921
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-04-16
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY656949-1163W00000X
NY340162363LF0000X
TXAP134157363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Single Specialty