Provider Demographics
NPI:1568882603
Name:HONG, HYEJEONG
Entity Type:Individual
Prefix:
First Name:HYEJEONG
Middle Name:
Last Name:HONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7332 EDEN BROOK DR
Mailing Address - Street 2:APT 1022
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1228
Mailing Address - Country:US
Mailing Address - Phone:312-919-8349
Mailing Address - Fax:
Practice Address - Street 1:7332 EDEN BROOK DR
Practice Address - Street 2:APT 1022
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1228
Practice Address - Country:US
Practice Address - Phone:312-919-8349
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-16
Last Update Date:2014-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209010839363LF0000X
MDR213320363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily