Basic Information
Provider Information
NPI: 1003800491
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HONG
FirstName: SOO
MiddleName: J.
NamePrefix: DR.
NameSuffix:  
Credential: M.D.
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 450 CLARKSON AVE
Address2: BOX 1262
City: BROOKLYN
State: NY
PostalCode: 112032056
CountryCode: US
TelephoneNumber: 7182708867
FaxNumber: 7182701794
Practice Location
Address1: 450 CLARKSON AVE
Address2:  
City: BROOKLYN
State: NY
PostalCode: 112032056
CountryCode: US
TelephoneNumber: 7182703126
FaxNumber: 7182703797
Other Information
ProviderEnumerationDate: 08/31/2005
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: X
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
207L00000X126503-1NYY Allopathic & Osteopathic PhysiciansAnesthesiology 

ID Information
IDTypeStateIssuerDescription
0064139605NY MEDICAID


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