Organization Name: | OSTEOPATHIC SPORTS & WELLNESS INSTITUTE |
NPI Number: | 1689948044 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | JOSEPH SUNGWOOK HONG (PRESIDENT/PROVIDER) |
Mailing Address: | 9834 Genesee Ave Suite 125 La Jolla |
State: | CA US |
Postal Code: | 920371269 |
Phone Number: | 8587201565 |
Fax Number: | |
NPI Enumeration Date: | 03/02/2012 |
NPI Last Update Date: | 03/02/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 204C00000X |
License Number: | 20A8140 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | Neuromusculoskeletal Medicine, Sports Medicine |
Taxonomy Specialization: | |
Taxonomy Definition: |