Provider Demographics
NPI:1659353068
Name:SHONG, DONG-HONG (MD)
Entity Type:Individual
Prefix:DR
First Name:DONG-HONG
Middle Name:
Last Name:SHONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13668 ROOSEVELT AVE # 4A
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5510
Mailing Address - Country:US
Mailing Address - Phone:718-539-3648
Mailing Address - Fax:
Practice Address - Street 1:13668 ROOSEVELT AVE # 4A
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:718-539-3648
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-20
Last Update Date:2021-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY189477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01722018Medicaid
NYF42925Medicare UPIN
NY01722018Medicaid