Provider Demographics
NPI:1184611634
Name:HONG, JAE UI (MD)
Entity type:Individual
Prefix:
First Name:JAE
Middle Name:UI
Last Name:HONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SOMERSET
Mailing Address - State:PA
Mailing Address - Zip Code:15501-2104
Mailing Address - Country:US
Mailing Address - Phone:814-445-5169
Mailing Address - Fax:814-443-6290
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:SOMERSET
Practice Address - State:PA
Practice Address - Zip Code:15501-2104
Practice Address - Country:US
Practice Address - Phone:814-445-5169
Practice Address - Fax:814-443-6290
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-30
Last Update Date:2009-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD059496L207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0018013740002Medicaid
838177OtherBCBS
110216603OtherPALMETTO GBA-RR MEDICARE
76444OtherTHREE RIVERS
123405OtherHEALTH AMERICA/ASSURANCE
207960OtherUPMC
946096OtherAETNA
946096OtherAETNA
838177OtherBCBS