Provider Demographics
NPI:1508175654
Name:STEPHEN S. HONG, M.D., A PROFESSIONAL CORP.
Entity Type:Organization
Organization Name:STEPHEN S. HONG, M.D., A PROFESSIONAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:S
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-486-1601
Mailing Address - Street 1:921 W. 7TH STREET
Mailing Address - Street 2:
Mailing Address - City:OXNARD
Mailing Address - State:CA
Mailing Address - Zip Code:93030-6755
Mailing Address - Country:US
Mailing Address - Phone:805-486-1601
Mailing Address - Fax:805-487-1094
Practice Address - Street 1:921 W. 7TH STREET
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-6755
Practice Address - Country:US
Practice Address - Phone:805-486-1601
Practice Address - Fax:805-487-1094
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STEPHEN S. HONG, M.D., A PROFESSIONAL CORPORATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-06
Last Update Date:2010-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA35437207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular DiseaseGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A354370Medicaid
CAA27784Medicare UPIN