Provider Demographics
NPI:1538194436
Name:HONG, JOHNNY C (MD)
Entity type:Individual
Prefix:
First Name:JOHNNY
Middle Name:C
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 VILLAGE SQUARE DR STE 200
Mailing Address - Street 2:
Mailing Address - City:PERRYSBURG
Mailing Address - State:OH
Mailing Address - Zip Code:43551-1762
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1103 VILLAGE SQUARE DR STE 200
Practice Address - Street 2:
Practice Address - City:PERRYSBURG
Practice Address - State:OH
Practice Address - Zip Code:43551-1762
Practice Address - Country:US
Practice Address - Phone:419-251-8760
Practice Address - Fax:419-214-6888
Is Sole Proprietor?:No
Enumeration Date:2006-07-11
Last Update Date:2024-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35.151258204F00000X
CAA86819204F00000X
PAMD479365204F00000X
WI58876204F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes204F00000XAllopathic & Osteopathic PhysiciansTransplant Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A868190Medicaid
PA1041137850001Medicaid
CA00A868190Medicaid