Provider Demographics
NPI:1619069911
Name:HONG, MELISSA S (DPM)
Entity type:Individual
Prefix:DR
First Name:MELISSA
Middle Name:S
Last Name:HONG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:715 NORTH PARK DRIVE
Mailing Address - Street 2:
Mailing Address - City:SELAH
Mailing Address - State:WA
Mailing Address - Zip Code:98942
Mailing Address - Country:US
Mailing Address - Phone:509-698-2624
Mailing Address - Fax:509-698-2664
Practice Address - Street 1:715 NORTH PARK DRIVE
Practice Address - Street 2:
Practice Address - City:SELAH
Practice Address - State:WA
Practice Address - Zip Code:98942
Practice Address - Country:US
Practice Address - Phone:509-698-2624
Practice Address - Fax:509-698-2664
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORDP185350213E00000X
WAPO504213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1025160002OtherDMER/CIGNA
WA480033168OtherRAILROAD MEDICARE
WA1084045Medicaid
WA7227BOOtherREGENCE BLUESHIELD
WA1025160001OtherDMER/CIGNA
WA103134OtherLABOR & INDUSTRY
WAHO2558OtherREGENCE BLUESHIELD
WA480033168OtherRAILROAD MEDICARE
WAGAB15305Medicare PIN
WAGAB27152Medicare PIN