Provider Demographics
NPI:1457717704
Name:HONG, LISA YUN
Entity Type:Individual
Prefix:
First Name:LISA
Middle Name:YUN
Last Name:HONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 E 17TH ST
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-8647
Mailing Address - Country:US
Mailing Address - Phone:714-543-8300
Mailing Address - Fax:714-543-8982
Practice Address - Street 1:2000 E 17TH ST
Practice Address - Street 2:
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92705-8647
Practice Address - Country:US
Practice Address - Phone:714-543-8300
Practice Address - Fax:714-543-8982
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66508183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist