Basic Information
Provider Information
NPI: 1245387166
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: HONG
FirstName: DAVID
MiddleName: KWANGMO
NamePrefix: DR.
NameSuffix:  
Credential: MD
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 300 PASTEUR DR
Address2: G312
City: STANFORD
State: CA
PostalCode: 943052200
CountryCode: US
TelephoneNumber:  
FaxNumber:  
Practice Location
Address1: 300 PASTEUR DR
Address2: G312
City: STANFORD
State: CA
PostalCode: 943052200
CountryCode: US
TelephoneNumber: 6507235682
FaxNumber: 6507258040
Other Information
ProviderEnumerationDate: 01/04/2007
LastUpdateDate: 07/08/2007
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
2080P0208XA79880CAY Allopathic & Osteopathic PhysiciansPediatricsPediatric Infectious Diseases

No ID Information.


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