Provider Demographics
NPI:1740388891
Name:KONG, GARY K (MD, MPH)
Entity Type:Individual
Prefix:DR
First Name:GARY
Middle Name:K
Last Name:KONG
Suffix:
Gender:M
Credentials:MD, MPH
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:3808 W RIVERSIDE DR
Mailing Address - Street 2:SUITE 406
Mailing Address - City:BURBANK
Mailing Address - State:CA
Mailing Address - Zip Code:91505-4325
Mailing Address - Country:US
Mailing Address - Phone:818-563-1449
Mailing Address - Fax:818-563-1049
Practice Address - Street 1:3808 W RIVERSIDE DR
Practice Address - Street 2:SUITE 406
Practice Address - City:BURBANK
Practice Address - State:CA
Practice Address - Zip Code:91505-4325
Practice Address - Country:US
Practice Address - Phone:818-563-1449
Practice Address - Fax:818-563-1049
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2012-04-10
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA51276207RC0200X, 207RP1001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RP1001XAllopathic & Osteopathic PhysiciansInternal MedicinePulmonary Disease
No207RC0200XAllopathic & Osteopathic PhysiciansInternal MedicineCritical Care Medicine