Provider Demographics
NPI:1538306923
Name:KONG, CHUNN L
Entity Type:Individual
Prefix:MR
First Name:CHUNN
Middle Name:L
Last Name:KONG
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 1:177 E WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:PEARL RIVER
Mailing Address - State:NY
Mailing Address - Zip Code:10965-2653
Mailing Address - Country:US
Mailing Address - Phone:845-735-4282
Mailing Address - Fax:
Practice Address - Street 1:177 E WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:PEARL RIVER
Practice Address - State:NY
Practice Address - Zip Code:10965-2653
Practice Address - Country:US
Practice Address - Phone:845-735-4282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-07
Last Update Date:2009-01-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY000384171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist