Provider Demographics
NPI:1831260199
Name:HONG, SAMUEL S K (MD)
Entity type:Individual
Prefix:DR
First Name:SAMUEL
Middle Name:S K
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:SEUNG
Other - Middle Name:KOOK
Other - Last Name:HONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:205 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RICHARDSON
Mailing Address - State:TX
Mailing Address - Zip Code:75081-3330
Mailing Address - Country:US
Mailing Address - Phone:972-680-9999
Mailing Address - Fax:972-680-9333
Practice Address - Street 1:205 E MAIN ST
Practice Address - Street 2:
Practice Address - City:RICHARDSON
Practice Address - State:TX
Practice Address - Zip Code:75081-3330
Practice Address - Country:US
Practice Address - Phone:972-680-9999
Practice Address - Fax:972-680-9333
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-10
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXF5950208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX034258601Medicaid
C17072Medicare UPIN
JT05Medicare ID - Type Unspecified