Provider Demographics
NPI:1922049055
Name:HONG, JEFFREY C (MD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:C
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:800 FAIRMOUNT AVE
Mailing Address - Street 2:219
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-3150
Mailing Address - Country:US
Mailing Address - Phone:626-844-7001
Mailing Address - Fax:626-844-7089
Practice Address - Street 1:800 FAIRMOUNT AVE
Practice Address - Street 2:219
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-3150
Practice Address - Country:US
Practice Address - Phone:626-844-7001
Practice Address - Fax:626-844-7089
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-09
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG71794207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G71794Medicaid
CA00G71794Medicaid
CABV699ZMedicare PIN