Provider Demographics
NPI:1013987205
Name:HONG, KAB S (MD)
Entity type:Individual
Prefix:DR
First Name:KAB
Middle Name:S
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 1:1349 W CHELTENHAM AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:ELKINS PARK
Mailing Address - State:PA
Mailing Address - Zip Code:19027-3141
Mailing Address - Country:US
Mailing Address - Phone:215-782-1610
Mailing Address - Fax:215-782-1620
Practice Address - Street 1:1349 W CHELTENHAM AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:ELKINS PARK
Practice Address - State:PA
Practice Address - Zip Code:19027-3141
Practice Address - Country:US
Practice Address - Phone:215-782-1610
Practice Address - Fax:215-782-1620
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-23
Last Update Date:2010-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD039474-L174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA070296Medicare UPIN