Provider Demographics
NPI:1700038601
Name:HONG, KENNETH H (DC)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:H
Last Name:HONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:556 W. VALLEY BLVD.
Mailing Address - Street 2:
Mailing Address - City:COLTON
Mailing Address - State:CA
Mailing Address - Zip Code:92324-2249
Mailing Address - Country:US
Mailing Address - Phone:909-824-1234
Mailing Address - Fax:909-423-0510
Practice Address - Street 1:556 W. VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:COLTON
Practice Address - State:CA
Practice Address - Zip Code:92324-2249
Practice Address - Country:US
Practice Address - Phone:909-824-1234
Practice Address - Fax:909-423-0510
Is Sole Proprietor?:No
Enumeration Date:2008-10-22
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC30750111N00000X
CADC 30750111NI0013X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor
No111NI0013XChiropractic ProvidersChiropractorIndependent Medical Examiner