Provider Demographics
NPI:1942906946
Name:HONG, JIWON JASON (DC)
Entity Type:Individual
Prefix:DR
First Name:JIWON
Middle Name:JASON
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 1:4450 CROMWELL AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90027-1250
Mailing Address - Country:US
Mailing Address - Phone:860-670-5225
Mailing Address - Fax:
Practice Address - Street 1:145 VISTA AVE STE 103
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91107-3699
Practice Address - Country:US
Practice Address - Phone:626-365-1380
Practice Address - Fax:626-808-4392
Is Sole Proprietor?:Yes
Enumeration Date:2023-02-01
Last Update Date:2023-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADC36555111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty