Provider Demographics
NPI:1891013603
Name:KONG, HEATHER M (MD)
Entity Type:Individual
Prefix:DR
First Name:HEATHER
Middle Name:M
Last Name:KONG
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Gender:F
Credentials:MD
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Mailing Address - Street 1:PO BOX 8500, LOCKBOX 7642
Mailing Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN PORTLAND
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19178-7642
Mailing Address - Country:US
Mailing Address - Phone:813-281-8115
Mailing Address - Fax:813-281-8656
Practice Address - Street 1:3101 SW SAM JACKSON PARK RD
Practice Address - Street 2:SHRINERS HOSPITAL FOR CHILDREN PORTLAND
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-3009
Practice Address - Country:US
Practice Address - Phone:503-221-3424
Practice Address - Fax:503-221-3490
Is Sole Proprietor?:No
Enumeration Date:2010-05-04
Last Update Date:2021-03-19
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Provider Licenses
StateLicense IDTaxonomies
MO2015005953207X00000X
ORMD179003207XP3100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207XP3100XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryPediatric Orthopaedic Surgery
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery