Provider Demographics
NPI:1609007806
Name:JAE Y HONG M D A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:JAE Y HONG M D A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ANESTHESIOLOGY
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:661-729-6854
Mailing Address - Street 1:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2858
Mailing Address - Country:US
Mailing Address - Phone:661-729-6854
Mailing Address - Fax:661-729-6864
Practice Address - Street 1:44301 LORIMER AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3700
Practice Address - Country:US
Practice Address - Phone:661-940-1112
Practice Address - Fax:661-723-6402
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-05
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318510Medicaid
CA00A318510OtherBLUE SHIELD
CA050066604OtherMEDICARE RAILROAD
CA050066604OtherMEDICARE RAILROAD
CA00A318510OtherBLUE SHIELD
CAWA31851AMedicare PIN