Provider Demographics
NPI:1659550028
Name:JAE UI. HONG
Entity Type:Organization
Organization Name:JAE UI. HONG
Other - Org Name:SOMERSET INTERNAL MEDICINE
Other - Org Type:Other Name
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAE
Authorized Official - Middle Name:UI
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-445-5169
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2104
Mailing Address - Country:US
Mailing Address - Phone:814-445-5169
Mailing Address - Fax:814-443-6290
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2104
Practice Address - Country:US
Practice Address - Phone:814-445-5169
Practice Address - Fax:814-443-6290
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-01
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059496L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA123405OtherHEALTH ASSURANCE
PA0016007050014Medicaid
PA207960OtherUPMC
PA76444OtherUNISON
1532377OtherUMWA
PA946096OtherAETNA
PA0018013740002Medicaid
110216603OtherPALMETTO GBA
838177OtherBLUE CROSS/ BLUE SHIELD
PA76444OtherUNISON
PA0016007050014Medicaid