Provider Demographics
NPI:1508368630
Name:YANG, KONG MENG
Entity Type:Individual
Prefix:
First Name:KONG
Middle Name:MENG
Last Name:YANG
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 1:6912 LOMBARDY LN
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL
Mailing Address - State:MN
Mailing Address - Zip Code:55428-2947
Mailing Address - Country:US
Mailing Address - Phone:763-276-5167
Mailing Address - Fax:
Practice Address - Street 1:600 GREENWOOD AVE LOT 26
Practice Address - Street 2:
Practice Address - City:TRACY
Practice Address - State:MN
Practice Address - Zip Code:56175
Practice Address - Country:US
Practice Address - Phone:763-276-5167
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-05
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN38OtherHOME HEALTH