1477200178 NPI number — HILL COUNTRY PRIMARY CARE PHYSICIANS

Table of content: SANG KWON HONG L.AC. (NPI 1801224480)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477200178 NPI number — HILL COUNTRY PRIMARY CARE PHYSICIANS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HILL COUNTRY PRIMARY CARE PHYSICIANS
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1477200178
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 835
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FREDERICKSBURG
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78624-0835
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
801 STEVE HAWKINS PKWY STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARBLE FALLS
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78654-6303
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-990-5871
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
KOTAL
Authorized Official First Name:
CLINTON
Authorized Official Middle Name:
Authorized Official Title or Position:
CHIO
Authorized Official Telephone Number:
830-990-1378

Provider Taxonomy Codes

  • Taxonomy code: 293D00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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