Provider Demographics
NPI:1881023257
Name:KSB GASTROENTEROLOGY
Entity Type:Organization
Organization Name:KSB GASTROENTEROLOGY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KONG
Authorized Official - Middle Name:PENG
Authorized Official - Last Name:YAP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-517-8669
Mailing Address - Street 1:33 CREEK RD
Mailing Address - Street 2:SUITE 380
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92604-4791
Mailing Address - Country:US
Mailing Address - Phone:949-517-8669
Mailing Address - Fax:
Practice Address - Street 1:33 CREEK RD
Practice Address - Street 2:SUITE 380
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92604-4791
Practice Address - Country:US
Practice Address - Phone:949-517-8669
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-06
Last Update Date:2013-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA101486207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty