Provider Demographics
NPI:1558930297
Name:HONG, IRENE LELIN (PA-C)
Entity Type:Individual
Prefix:
First Name:IRENE
Middle Name:LELIN
Last Name:HONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9143 VALLEY BLVD STE 201A
Mailing Address - Street 2:
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-1992
Mailing Address - Country:US
Mailing Address - Phone:626-872-0657
Mailing Address - Fax:
Practice Address - Street 1:9143 VALLEY BLVD STE 201A
Practice Address - Street 2:
Practice Address - City:ROSEMEAD
Practice Address - State:CA
Practice Address - Zip Code:91770-1992
Practice Address - Country:US
Practice Address - Phone:626-872-0657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-17
Last Update Date:2022-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
363A00000X
CA59680363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant