Provider Demographics
NPI:1346227188
Name:KONG, INSU (MD)
Entity Type:Individual
Prefix:
First Name:INSU
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:31 CRESTVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WESTERLY
Mailing Address - State:RI
Mailing Address - Zip Code:02891-2901
Mailing Address - Country:US
Mailing Address - Phone:401-596-9939
Mailing Address - Fax:401-596-9637
Practice Address - Street 1:31 CRESTVIEW DR
Practice Address - Street 2:
Practice Address - City:WESTERLY
Practice Address - State:RI
Practice Address - Zip Code:02891-2901
Practice Address - Country:US
Practice Address - Phone:401-596-9939
Practice Address - Fax:401-596-9637
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI10135207VG0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VG0400XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
RI9002855Medicaid
010010135R101OtherANTHEM
RI128554OtherBCBS
0701186OtherUHC
P22447OtherOXFORD
OV6530OtherHEALTHNET
0701186OtherUHC