Provider Demographics
NPI:1851720239
Name:KONG, YUEN LING WONG (PA-C)
Entity Type:Individual
Prefix:
First Name:YUEN LING
Middle Name:WONG
Last Name:KONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3460 OLD WASHINGTON RD
Mailing Address - Street 2:SUITE 203A
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20602-3240
Mailing Address - Country:US
Mailing Address - Phone:301-638-0602
Mailing Address - Fax:301-638-7558
Practice Address - Street 1:3460 OLD WASHINGTON RD
Practice Address - Street 2:SUITE 203A
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20602-3240
Practice Address - Country:US
Practice Address - Phone:301-638-0602
Practice Address - Fax:301-638-7558
Is Sole Proprietor?:No
Enumeration Date:2013-11-05
Last Update Date:2013-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0110-004388363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant