Provider Demographics
NPI:1457310005
Name:KAUH, BONG S (MD)
Entity Type:Individual
Prefix:
First Name:BONG
Middle Name:S
Last Name:KAUH
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:111 STOW AVE STE 200
Mailing Address - Street 2:
Mailing Address - City:CUYAHOGA FALLS
Mailing Address - State:OH
Mailing Address - Zip Code:44221-2560
Mailing Address - Country:US
Mailing Address - Phone:330-564-2629
Mailing Address - Fax:330-546-7758
Practice Address - Street 1:4242 COBBLESTONE DR
Practice Address - Street 2:
Practice Address - City:COPLEY
Practice Address - State:OH
Practice Address - Zip Code:44321-2925
Practice Address - Country:US
Practice Address - Phone:330-666-5617
Practice Address - Fax:330-666-5657
Is Sole Proprietor?:No
Enumeration Date:2006-03-22
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
OH35057848207QG0300X, 207RG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207RG0300XAllopathic & Osteopathic PhysiciansInternal MedicineGeriatric Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHP00478827OtherRAILROAD MEDICARE
OH000000561240OtherANTHEM
OH0809647Medicaid
OHP00478827OtherRAILROAD MEDICARE