Provider Demographics
NPI:1346460482
Name:KONG, SUNG D (ACUPUNCTURIST)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:D
Last Name:KONG
Suffix:
Gender:M
Credentials:ACUPUNCTURIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 NEWMARK MALL
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-4739
Mailing Address - Country:US
Mailing Address - Phone:323-888-0304
Mailing Address - Fax:
Practice Address - Street 1:712 NEWMARK MALL
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-4739
Practice Address - Country:US
Practice Address - Phone:323-888-0304
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC51580171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist