Provider Demographics
NPI:1952311938
Name:HONG, SHIRLEY SHIAO-HUI (OD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:SHIAO-HUI
Last Name:HONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4247 PACIFIC COAST HWY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-5525
Mailing Address - Country:US
Mailing Address - Phone:424-341-3931
Mailing Address - Fax:424-341-3932
Practice Address - Street 1:1380 FULLERTON RD STE 103
Practice Address - Street 2:
Practice Address - City:ROWLAND HEIGHTS
Practice Address - State:CA
Practice Address - Zip Code:91748-1250
Practice Address - Country:US
Practice Address - Phone:619-200-6890
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2016-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA12811T152WL0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152WL0500XEye and Vision Services ProvidersOptometristLow Vision Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB204596OtherMEDICARE PTAN
CACB246120OtherMEDICARE PTAN