Provider Demographics
NPI:1023444981
Name:ISHAKU, HONG U
Entity type:Individual
Prefix:
First Name:HONG
Middle Name:U
Last Name:ISHAKU
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2904 CRESTLINE DR
Mailing Address - Street 2:
Mailing Address - City:LAWRENCE
Mailing Address - State:KS
Mailing Address - Zip Code:66047-3065
Mailing Address - Country:US
Mailing Address - Phone:785-832-1360
Mailing Address - Fax:
Practice Address - Street 1:2904 CRESTLINE DR
Practice Address - Street 2:
Practice Address - City:LAWRENCE
Practice Address - State:KS
Practice Address - Zip Code:66047-3065
Practice Address - Country:US
Practice Address - Phone:785-832-1360
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-23
Last Update Date:2013-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKSA75-3307B171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor