Provider Demographics
NPI:1619309374
Name:KONG, DAVID Y (OD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:Y
Last Name:KONG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:84 OLD DEERFIELD PIKE
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:NJ
Mailing Address - Zip Code:08302-3745
Mailing Address - Country:US
Mailing Address - Phone:609-230-2210
Mailing Address - Fax:
Practice Address - Street 1:509 STILLWELLS CORNER RD
Practice Address - Street 2:SUITE E5
Practice Address - City:FREEHOLD
Practice Address - State:NJ
Practice Address - Zip Code:07728-2965
Practice Address - Country:US
Practice Address - Phone:732-431-9333
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-08-05
Last Update Date:2013-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ27OA00649100152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist