Provider Demographics
NPI:1639483472
Name:HONG, SUNG JAE (LAC)
Entity Type:Individual
Prefix:MR
First Name:SUNG
Middle Name:JAE
Last Name:HONG
Suffix:
Gender:M
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 KINDERKAMACK RD STE 207N
Mailing Address - Street 2:
Mailing Address - City:ORADELL
Mailing Address - State:NJ
Mailing Address - Zip Code:07649-1546
Mailing Address - Country:US
Mailing Address - Phone:201-313-0501
Mailing Address - Fax:877-500-5573
Practice Address - Street 1:800 KINDERKAMACK RD STE 207N
Practice Address - Street 2:
Practice Address - City:ORADELL
Practice Address - State:NJ
Practice Address - Zip Code:07649-1546
Practice Address - Country:US
Practice Address - Phone:201-313-0501
Practice Address - Fax:877-500-5573
Is Sole Proprietor?:No
Enumeration Date:2010-08-04
Last Update Date:2017-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MZ00019800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist