Provider Demographics
NPI:1689948044
Name:OSTEOPATHIC SPORTS & WELLNESS INSTITUTE
Entity Type:Organization
Organization Name:OSTEOPATHIC SPORTS & WELLNESS INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:SUNGWOOK
Authorized Official - Last Name:HONG
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:858-720-1565
Mailing Address - Street 1:9834 GENESEE AVE
Mailing Address - Street 2:SUITE 125
Mailing Address - City:LA JOLLA
Mailing Address - State:CA
Mailing Address - Zip Code:92037-1269
Mailing Address - Country:US
Mailing Address - Phone:858-720-1565
Mailing Address - Fax:
Practice Address - Street 1:9834 GENESEE AVE
Practice Address - Street 2:SUITE 125
Practice Address - City:LA JOLLA
Practice Address - State:CA
Practice Address - Zip Code:92037-1269
Practice Address - Country:US
Practice Address - Phone:858-720-1565
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A8140204C00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes204C00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine, Sports MedicineGroup - Single Specialty