1659550028 NPI number — JAE UI. HONG

Table of content: (NPI 1659550028)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1659550028 NPI number — JAE UI. HONG

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
JAE UI. HONG
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:
6
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:
1659550028
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/17/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 E MAIN ST
Provider Second Line Business Mailing Address:
SUITE 100
Provider Business Mailing Address City Name:
SOMERSET
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
15501-2104
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
814-445-5169
Provider Business Mailing Address Fax Number:
814-443-6290

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
321 E MAIN ST
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
SOMERSET
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
15501-2104
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
814-445-5169
Provider Business Practice Location Address Fax Number:
814-443-6290
Provider Enumeration Date:
11/01/2007

Additional Information

Authorized Official

Authorized Official Last Name:
HONG
Authorized Official First Name:
JAE
Authorized Official Middle Name:
UI
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
814-445-5169

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  MD059496L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 123405 . This is a "HEALTH ASSURANCE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0016007050014 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 207960 . This is a "UPMC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 76444 . This is a "UNISON" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1532377 . This is a "UMWA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 946096 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0018013740002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 110216603 . This is a "PALMETTO GBA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 838177 . This is a "BLUE CROSS/ BLUE SHIELD" identifier . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com