Provider Demographics
NPI:1225129141
Name:KONG, RONALD G (MD)
Entity Type:Individual
Prefix:DR
First Name:RONALD
Middle Name:G
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 1:1930 VILLAGE CENTER CIR
Mailing Address - Street 2:BOX 3-532
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89134-6238
Mailing Address - Country:US
Mailing Address - Phone:702-382-3331
Mailing Address - Fax:702-382-5925
Practice Address - Street 1:501 S RANCHO DR STE A5
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4829
Practice Address - Country:US
Practice Address - Phone:702-382-3331
Practice Address - Fax:702-382-5925
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2021-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8608208100000X, 207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV002002928Medicaid
NV37754Medicare PIN
NVG66136Medicare UPIN