Provider Demographics
NPI:1902017502
Name:HONG, JUNG (MD)
Entity Type:Individual
Prefix:DR
First Name:JUNG
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1329 LUSITANA ST STE 604
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2431
Mailing Address - Country:US
Mailing Address - Phone:808-531-1116
Mailing Address - Fax:925-543-0145
Practice Address - Street 1:1329 LUSITANA ST STE 604
Practice Address - Street 2:
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2431
Practice Address - Country:US
Practice Address - Phone:808-531-1116
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD60024615207L00000X
CAA93019207L00000X
HIMD22424207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8520157Medicaid
G8875285Medicare PIN
WA8520157Medicaid