Provider Demographics
NPI:1578668703
Name:HONG, GREGORY K (MD)
Entity Type:Individual
Prefix:DR
First Name:GREGORY
Middle Name:K
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:520 S VIRGIL AVE
Mailing Address - Street 2:SUITE 501
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90020-1416
Mailing Address - Country:US
Mailing Address - Phone:213-381-0700
Mailing Address - Fax:213-381-8700
Practice Address - Street 1:520 S VIRGIL AVE
Practice Address - Street 2:SUITE 501
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90020-1416
Practice Address - Country:US
Practice Address - Phone:213-381-0700
Practice Address - Fax:213-381-8700
Is Sole Proprietor?:No
Enumeration Date:2006-09-13
Last Update Date:2015-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA53990207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A539900OtherBLUE SHIELD
CA00A539900Medicaid
096843OtherCHAMPUS
G80388Medicare UPIN
CA00A539900Medicaid