Basic Information
| Provider Information | |||||||||
| NPI: | 1316079908 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HONG | ||||||||
| FirstName: | DAVID | ||||||||
| MiddleName: | IN-CHULL | ||||||||
| NamePrefix: | DR. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 111 CYPRESS ST | ||||||||
| Address2: | |||||||||
| City: | BROOKLINE | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024456002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8573070896 | ||||||||
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| Practice Location | |||||||||
| Address1: | 850 BOYLSTON ST | ||||||||
| Address2: | SUITE 540 | ||||||||
| City: | CHESTNUT HILL | ||||||||
| State: | MA | ||||||||
| PostalCode: | 024672477 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6177329850 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/10/2007 | ||||||||
| LastUpdateDate: | 06/06/2012 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207K00000X | 222679 | MA | Y | Allopathic & Osteopathic Physicians | Allergy & Immunology |
ID Information
| ID | Type | State | Issuer | Description | 2152461 | 05 | MA | MEDICAID | J42980 | 01 | BCBS OF MASSACHUSETTS | OTHER |