1073710067 NPI number — DR. MAURICIO HONG MD

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073710067 NPI number — DR. MAURICIO HONG MD

Employer Identification Number (EIN):

Provider Organization Name:

Provider Last Name:

HONG

Provider First Name:

MAURICIO

Provider Middle Name:

Provider Name Prefix Text:

DR.

Provider Name Suffix Text:

Provider Credential Text:

MD

Provider Gender Code:

M

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:

1073710067

Entity Type Code:

Individual

Replacement NPI:

Last Update Date:

12/12/2014

NPI Deactivation Reason Code:

NPI Deactivation Date:

NPI Reactivation Date:

Provider First Line Business Mailing Address:

1400 N IH 35

Provider Second Line Business Mailing Address:

SUITE 300

Provider Business Mailing Address City Name:

AUSTIN

Provider Business Mailing Address State Name:

TX

Provider Business Mailing Address Postal Code:

78701-1926

Provider Business Mailing Address Country Code:

US

Provider Business Mailing Address Telephone Number:

512-324-8300

Provider Business Mailing Address Fax Number:

512-324-8301

Provider First Line Business Practice Location Address:

1301 W 38TH ST

Provider Second Line Business Practice Location Address:

SUITE 400

Provider Business Practice Location Address City Name:

AUSTIN

Provider Business Practice Location Address State Name:

TX

Provider Business Practice Location Address Postal Code:

78705-1000

Provider Business Practice Location Address Country Code:

US

Provider Business Practice Location Address Telephone Number:

512-324-3440

Provider Business Practice Location Address Fax Number:

512-406-6513

Provider Enumeration Date:

07/02/2007

Authorized Official Last Name:

Authorized Official First Name:

Authorized Official Middle Name:

Authorized Official Title or Position:

Authorized Official Telephone Number:

• Taxonomy code: 207RC0000X , with the licence number:  4301084739 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: N1682 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0001X , with the licence number: 4301084739 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0000X , with the licence number: 35-092689 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
• Taxonomy code: 207RC0001X , with the licence number: N1682 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

• Identifier: 2941482 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
• Identifier: 8DW971 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 323947701 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 323947703 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 323947702 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".
• Identifier: 8ET188 . This is a "BCBS" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
• Identifier: 323947704 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".