Provider Demographics
NPI:1659546117
Name:HONG, JAE HO (MD)
Entity Type:Individual
Prefix:DR
First Name:JAE HO
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:JAE
Other - Middle Name:HO
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:3601 5TH AVE STE 3A
Mailing Address - Street 2:FALK MEDICAL BUILDING
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15213-3403
Mailing Address - Country:US
Mailing Address - Phone:412-648-6401
Mailing Address - Fax:
Practice Address - Street 1:3601 5TH AVE STE 3A
Practice Address - Street 2:FALK MEDICAL BUILDING
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15213-3403
Practice Address - Country:US
Practice Address - Phone:412-648-6401
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-25
Last Update Date:2013-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MA08437700207R00000X
PAMD434964207R00000X, 207RI0200X
PAMT197982207RI0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0200XAllopathic & Osteopathic PhysiciansInternal MedicineInfectious Disease
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAMT197982OtherSTATE MEDICAL LICENSE
NJMA08437700OtherSTATE MEDICAL LICENSE
PAMD434964OtherSTATE MEDICAL LICENSE