Provider Demographics
NPI:1376207894
Name:OUNKONG, KIMY
Entity Type:Individual
Prefix:MR
First Name:KIMY
Middle Name:
Last Name:OUNKONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4230 YORK LN NW
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:MN
Mailing Address - Zip Code:55901-5858
Mailing Address - Country:US
Mailing Address - Phone:507-440-5880
Mailing Address - Fax:
Practice Address - Street 1:4230 YORK LN NW
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:MN
Practice Address - Zip Code:55901-5858
Practice Address - Country:US
Practice Address - Phone:507-440-5880
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-30
Last Update Date:2021-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program