Provider Demographics
NPI:1124013214
Name:JONG, KEVIN Y (MD)
Entity Type:Individual
Prefix:DR
First Name:KEVIN
Middle Name:Y
Last Name:JONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:KEVIN
Other - Middle Name:Y
Other - Last Name:JONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:2855 GRAMERCY ST # 400
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77025-1697
Mailing Address - Country:US
Mailing Address - Phone:713-668-6828
Mailing Address - Fax:
Practice Address - Street 1:1415 NORTH LOOP W STE 400
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77008-1646
Practice Address - Country:US
Practice Address - Phone:713-869-6400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-14
Last Update Date:2021-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK1489207W00000X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX039760603Medicaid
TXG34642Medicare UPIN
TX8B5260Medicare PIN