Active NPI
Peter Kooghee Hong
- Geriatric Medicine (Internal Medicine) Physician
- Dallas, TX
National Provider Identifier
1255674750
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Geriatric Medicine (Internal Medicine) Physician
- License
- R5565
- Practice address
- 4500 S Lancaster Rd.
Community Living Center
Dallas, TX 75216 - Phone
- (214) 857-1731
- NPI assigned
- Apr 3, 2013
- Last updated
- Mar 30, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Geriatric Medicine (Internal Medicine) Physician | 207RG0300X | R5565 | TX | Primary |
Addresses
Primary practice location
4500 S Lancaster Rd.
Community Living Center
Dallas, TX 75216
Mailing address
4500 S Lancaster Rd.
Community Living Center
Dallas, TX 75216-7167
Other practice location 1
20 York St
Yale New Haven Hospital Department of Geriatrics
New Haven, CT 06510-3220
Phone (203) 688-9423
Other practice location 2
5323 Harry Hines Blvd
Dallas, TX 75390-3220
Phone (214) 590-8058
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: Yes
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| R5565 | TX | MD | Geriatric Medicine (Internal Medicine) Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1364947200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1680134400000",
"number": "1255674750",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "4500 S LANCASTER RD.",
"address_2": "COMMUNITY LIVING CENTER",
"city": "DALLAS",
"state": "TX",
"postal_code": "752167167"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "4500 S LANCASTER RD.",
"address_2": "COMMUNITY LIVING CENTER",
"city": "DALLAS",
"state": "TX",
"postal_code": "75216",
"telephone_number": "214-857-1731"
}
],
"practiceLocations": [
{
"address_1": "20 York St",
"address_2": "Yale New Haven Hospital Department of Geriatrics",
"address_purpose": "LOCATION",
"city": "New Haven",
"state": "CT",
"postal_code": "065103220",
"country_code": "US",
"telephone_number": "203-688-9423",
"country_name": "United States",
"address_type": "DOM"
},
{
"address_1": "5323 Harry Hines Blvd",
"address_purpose": "LOCATION",
"city": "Dallas",
"state": "TX",
"postal_code": "753903220",
"country_code": "US",
"telephone_number": "214-590-8058",
"country_name": "United States",
"address_type": "DOM"
}
],
"basic": {
"last_name": "HONG",
"first_name": "PETER",
"middle_name": "KOOGHEE",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2013-04-03",
"last_updated": "2023-03-30",
"certification_date": "2021-10-19",
"status": "A"
},
"taxonomies": [
{
"code": "207RG0300X",
"taxonomy_group": "",
"desc": "Internal Medicine, Geriatric Medicine",
"state": "TX",
"license": "R5565",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dallas, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 30, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.