Provider Demographics
NPI:1083609879
Name:KONG, CHAU KAI (DPM)
Entity Type:Individual
Prefix:DR
First Name:CHAU KAI
Middle Name:
Last Name:KONG
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 1:301 OMNI DR
Mailing Address - Street 2:
Mailing Address - City:HILLSBOROUGH
Mailing Address - State:NJ
Mailing Address - Zip Code:08844-4526
Mailing Address - Country:US
Mailing Address - Phone:908-874-7592
Mailing Address - Fax:908-874-0755
Practice Address - Street 1:301 OMNI DR
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NJ
Practice Address - Zip Code:08844-4526
Practice Address - Country:US
Practice Address - Phone:908-874-7592
Practice Address - Fax:908-874-0755
Is Sole Proprietor?:Yes
Enumeration Date:2005-09-17
Last Update Date:2016-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MD00127000213EP1101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213EP1101XPodiatric Medicine & Surgery Service ProvidersPodiatristPrimary Podiatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ4695003Medicaid
NJT45005Medicare UPIN
NJ350726Medicare PIN
NJ4695003Medicaid