Provider Demographics
NPI:1790790665
Name:EKONG MEDICAL CORPORATION
Entity Type:Organization
Organization Name:EKONG MEDICAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:HARI
Authorized Official - Middle Name:
Authorized Official - Last Name:CHANDRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-726-3058
Mailing Address - Street 1:43847 HEATON AVE
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:CA
Mailing Address - Zip Code:93534-4936
Mailing Address - Country:US
Mailing Address - Phone:661-726-3058
Mailing Address - Fax:661-726-3723
Practice Address - Street 1:43860 N. 10TH ST. WEST
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:CA
Practice Address - Zip Code:93534-4936
Practice Address - Country:US
Practice Address - Phone:661-726-3060
Practice Address - Fax:661-726-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-29
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty