Provider Demographics
NPI:1821678095
Name:CHRISTOPHER KONG MD INC.
Entity Type:Organization
Organization Name:CHRISTOPHER KONG MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:310-423-9779
Mailing Address - Street 1:444 S SAN VICENTE BLVD STE 901
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-4174
Mailing Address - Country:US
Mailing Address - Phone:310-734-6848
Mailing Address - Fax:
Practice Address - Street 1:444 S SAN VICENTE BLVD STE 901
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-4174
Practice Address - Country:US
Practice Address - Phone:503-380-1592
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-12
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207XS0117XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryOrthopaedic Surgery of the SpineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1821678095OtherHEALTH NET
1821678095OtherMULTIPLAN
1821678095OtherTRICARE
1821678095OtherCIGNA
1821678095OtherPROSPECT MEDICAL GROUP
1821678095OtherUMR
1821678095OtherAETNA
1821678095OtherCOVENTRY
1821678095OtherBLUE CROSS
1821678095OtherOPERATING ENGINEERS
1821678095OtherUNITED HEALTHCARE
1821678095OtherBLUE SHIELD