Provider Demographics
NPI:1669804589
Name:HONG, KEVIN (OD)
Entity type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:
Last Name:HONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3929 N WESTERN AVE
Mailing Address - Street 2:STORE S
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-3759
Mailing Address - Country:US
Mailing Address - Phone:773-906-5725
Mailing Address - Fax:773-906-5724
Practice Address - Street 1:3929 N WESTERN AVE
Practice Address - Street 2:STORE S
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-3759
Practice Address - Country:US
Practice Address - Phone:773-906-5725
Practice Address - Fax:773-906-5724
Is Sole Proprietor?:No
Enumeration Date:2013-08-01
Last Update Date:2016-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL046010719152W00000X
IN18003811A152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400094349Medicare PIN