Provider Demographics
NPI:1558662478
Name:HONG, CHARLIE CHIA HSUN (CRNA)
Entity Type:Individual
Prefix:
First Name:CHARLIE
Middle Name:CHIA HSUN
Last Name:HONG
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 S 1ST AVE STE 25A
Mailing Address - Street 2:
Mailing Address - City:IOWA CITY
Mailing Address - State:IA
Mailing Address - Zip Code:52240-6036
Mailing Address - Country:US
Mailing Address - Phone:319-849-8114
Mailing Address - Fax:319-333-0624
Practice Address - Street 1:1700 S 1ST AVE STE 25A
Practice Address - Street 2:
Practice Address - City:IOWA CITY
Practice Address - State:IA
Practice Address - Zip Code:52240-6036
Practice Address - Country:US
Practice Address - Phone:319-849-8114
Practice Address - Fax:319-333-0624
Is Sole Proprietor?:No
Enumeration Date:2010-11-09
Last Update Date:2021-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.014002367500000X
PARN620237367500000X
IAD139273367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered