Provider Demographics
NPI:1780728220
Name:HONG, KYUNG R (OD)
Entity type:Individual
Prefix:MRS
First Name:KYUNG
Middle Name:R
Last Name:HONG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5630 W. DEMPSTER ST.
Mailing Address - Street 2:
Mailing Address - City:MORTON GROVE
Mailing Address - State:IL
Mailing Address - Zip Code:60053
Mailing Address - Country:US
Mailing Address - Phone:847-581-1891
Mailing Address - Fax:847-581-1887
Practice Address - Street 1:5630 W. DEMPSTER ST.
Practice Address - Street 2:
Practice Address - City:MORTON GROVE
Practice Address - State:IL
Practice Address - Zip Code:60053
Practice Address - Country:US
Practice Address - Phone:847-581-1891
Practice Address - Fax:847-581-1887
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL460008570152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL5848Medicare PIN