Provider Demographics
NPI:1760483838
Name:HONG, PETER YOUNGKI (RPH)
Entity Type:Individual
Prefix:
First Name:PETER
Middle Name:YOUNGKI
Last Name:HONG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12145 STONE GATE WAY
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91326-3854
Mailing Address - Country:US
Mailing Address - Phone:818-366-3071
Mailing Address - Fax:818-716-1229
Practice Address - Street 1:12145 STONE GATE WAY
Practice Address - Street 2:
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91326-3854
Practice Address - Country:US
Practice Address - Phone:818-366-3071
Practice Address - Fax:818-716-1229
Is Sole Proprietor?:No
Enumeration Date:2005-08-10
Last Update Date:2007-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH50454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist