Basic Information
| Provider Information | |||||||||
| NPI: | 1316974876 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | YONGSMITH | ||||||||
| FirstName: | HOPE | ||||||||
| MiddleName: | R | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 6001 | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581086001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Practice Location | |||||||||
| Address1: | 1702 UNIVERSITY DR S | ||||||||
| Address2: | |||||||||
| City: | FARGO | ||||||||
| State: | ND | ||||||||
| PostalCode: | 581034940 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7013643300 | ||||||||
| FaxNumber: | 7013648906 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/28/2006 | ||||||||
| LastUpdateDate: | 07/09/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207W00000X | 7916 | ND | Y | Allopathic & Osteopathic Physicians | Ophthalmology | 207W00000X | 40848 | MN | N | Allopathic & Osteopathic Physicians | Ophthalmology |
ID Information
| ID | Type | State | Issuer | Description | 10695 | 05 | ND | MEDICAID | 61D19YO | 01 | MN | MNBS # | OTHER | 933S8YO | 01 | ND | MNBS # | OTHER | ND200032 | 01 | ND | LHS # | OTHER | 15928 | 01 | ND | NDBS # | OTHER | BY5838935 | 01 | ND | DEA # | OTHER | 55D02YO | 01 | ND | MNBS # | OTHER | 15924 | 01 | MN | NDBS # | OTHER | 807916 | 01 | ND | ND VISION # | OTHER | 911587 | 01 | ND | AMERICA'S PPO/ARAZ # | OTHER |