Provider Demographics
NPI:1184904401
Name:TO, HONG (MA)
Entity type:Individual
Prefix:MR
First Name:HONG
Middle Name:
Last Name:TO
Suffix:
Gender:M
Credentials:MA
Other - Prefix:MR
Other - First Name:JERRY
Other - Middle Name:
Other - Last Name:TO
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:2615 MUSCATEL AVE
Mailing Address - Street 2:APT. F
Mailing Address - City:ROSEMEAD
Mailing Address - State:CA
Mailing Address - Zip Code:91770-3382
Mailing Address - Country:US
Mailing Address - Phone:310-951-4162
Mailing Address - Fax:
Practice Address - Street 1:11041 VALLEY BLVD
Practice Address - Street 2:
Practice Address - City:EL MONTE
Practice Address - State:CA
Practice Address - Zip Code:91731-2516
Practice Address - Country:US
Practice Address - Phone:626-442-4177
Practice Address - Fax:626-442-4498
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-17
Last Update Date:2011-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)