Active NPI
Jisoo Hong, DDS
- Dentist
- Manitowoc, WI
National Provider Identifier
1902509466
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 6000060-15
- Practice address
- 2719 Calumet Ave
Manitowoc, WI 54220-5546 - Phone
- (920) 686-2333
- NPI assigned
- Mar 23, 2023
- Last updated
- Sep 24, 2024
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Dentist | 122300000X | 6000060-15 | WI | Primary |
Addresses
Primary practice location
2719 Calumet Ave
Manitowoc, WI 54220-5546
Mailing address
2719 Calumet Ave
Manitowoc, WI 54220-5546
Phone (920) 686-2333
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in WI
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20241112000547 | WI | Order and Referring Only - Dentist | 8820522063 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6000060-15 | WI | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679529600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1727136000000",
"number": "1902509466",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2719 CALUMET AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542205546",
"telephone_number": "920-686-2333"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2719 CALUMET AVE",
"city": "MANITOWOC",
"state": "WI",
"postal_code": "542205546",
"telephone_number": "920-686-2333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HONG",
"first_name": "JISOO",
"credential": "DDS",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2023-03-23",
"last_updated": "2024-09-24",
"certification_date": "2024-09-24",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "WI",
"license": "6000060-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Manitowoc, WI
- Holy Family Memorial Inc
- Holy Family Memorial Inc (Froedtert Holy Family Memorial Hospital)
- Holy Family Memorial, Inc (Holy Family Memorial Medical Center)
- Homecare Health Services Inc
- Homecare Health Services Inc (Manitowoc County Community Hospice)
- Nathaniel Garner Hope, DPT
- Horizon Chiropractic Center LLC
- Kristi L Horneck, PT, DPT
- Lawrence Richard Huck II
- Margaret Huebbe, SLP
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 24, 2024; 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.