Provider Demographics
NPI:1578657391
Name:HONG, KYUNG HWAN (OD)
Entity Type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:HWAN
Last Name:HONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1507
Mailing Address - Country:US
Mailing Address - Phone:860-893-7016
Mailing Address - Fax:860-893-7017
Practice Address - Street 1:405 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1507
Practice Address - Country:US
Practice Address - Phone:860-893-7016
Practice Address - Fax:860-893-7017
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-03
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA4186152WC0802X
CT002654152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No152WC0802XEye and Vision Services ProvidersOptometristCorneal and Contact Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0335291Medicaid
MA0335291Medicaid
W17317Medicare ID - Type Unspecified