Provider Demographics
NPI:1225092984
Name:KONG, JUN HO (MD)
Entity Type:Individual
Prefix:DR
First Name:JUN
Middle Name:HO
Last Name:KONG
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 1:4161 MCKINNEY AVE
Mailing Address - Street 2:SUITE 300
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-8213
Mailing Address - Country:US
Mailing Address - Phone:214-219-6655
Mailing Address - Fax:214-219-6660
Practice Address - Street 1:4161 MCKINNEY AVE
Practice Address - Street 2:SUITE 300
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-8213
Practice Address - Country:US
Practice Address - Phone:214-219-6655
Practice Address - Fax:214-219-6660
Is Sole Proprietor?:No
Enumeration Date:2006-04-12
Last Update Date:2023-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXK9319207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8B4289OtherBCBS
TX147042901Medicaid
TX147042902Medicaid
TX080178608Medicare PIN
TX8B4289OtherBCBS
TX147042901Medicaid