Provider Demographics
NPI:1093827883
Name:HONG, JAEKYOUNG AUDREY (MD)
Entity Type:Individual
Prefix:DR
First Name:JAEKYOUNG
Middle Name:AUDREY
Last Name:HONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:520 MEDICAL CENTER DR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-4314
Mailing Address - Country:US
Mailing Address - Phone:541-930-7222
Mailing Address - Fax:541-930-7220
Practice Address - Street 1:520 MEDICAL CENTER DR
Practice Address - Street 2:SUITE 200
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-4314
Practice Address - Country:US
Practice Address - Phone:541-930-7222
Practice Address - Fax:541-930-7220
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60091925207RI0011X, 207RC0000X
ORMD177602207RI0011X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease