Provider Demographics
NPI:1386814762
Name:RONALD G KONG MD PC
Entity Type:Organization
Organization Name:RONALD G KONG MD PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:G
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-382-3331
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
Practice Address - Street 2:SUITE A-5
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4828
Practice Address - Country:US
Practice Address - Phone:702-382-3331
Practice Address - Fax:702-382-5925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-03
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8608208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NVG66136Medicare UPIN
NVV37753Medicare PIN