Provider Demographics
NPI:1790997716
Name:HONG DO MD A PROFESSIONAL CORPORATION
Entity Type:Organization
Organization Name:HONG DO MD A PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DERMATOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:T N
Authorized Official - Last Name:DO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:408-223-6073
Mailing Address - Street 1:1692 TULLY RD STE 9
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-2550
Mailing Address - Country:US
Mailing Address - Phone:408-223-6073
Mailing Address - Fax:408-223-8030
Practice Address - Street 1:1692 TULLY RD STE 9
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95122-2550
Practice Address - Country:US
Practice Address - Phone:408-223-6073
Practice Address - Fax:408-223-8030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2011-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA41726174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0087117Medicaid
CA00A41726Medicare ID - Type Unspecified
CA0087117Medicaid