Provider Demographics
NPI:1891973194
Name:TAM, CONNIE CHUNG KONG (MD)
Entity Type:Individual
Prefix:DR
First Name:CONNIE CHUNG KONG
Middle Name:
Last Name:TAM
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:4240 BOWNE ST APT 1C
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-2802
Mailing Address - Country:US
Mailing Address - Phone:718-939-1182
Mailing Address - Fax:718-939-0563
Practice Address - Street 1:4240 BOWNE ST APT 1C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11355-2802
Practice Address - Country:US
Practice Address - Phone:718-939-1182
Practice Address - Fax:718-939-0563
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-08
Last Update Date:2019-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY172862207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY43I742Medicare UPIN