Provider Demographics
NPI:1538197082
Name:HONG, JAE Y (MD)
Entity type:Individual
Prefix:DR
First Name:JAE
Middle Name:Y
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:PO BOX 2858
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93539-2858
Mailing Address - Country:US
Mailing Address - Phone:661-729-6854
Mailing Address - Fax:661-729-6864
Practice Address - Street 1:44301 LORIMER AVE
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-3700
Practice Address - Country:US
Practice Address - Phone:661-940-1110
Practice Address - Fax:661-723-6402
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-30
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31851174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A318510Medicaid
CA050066604OtherRAILROAD MEDICARE
CA00A318510OtherBLUE SHIELD OF CA
CA00A318510OtherBLUE SHIELD OF CA
CAA84274Medicare UPIN
CA00A318510Medicaid