Provider Demographics
NPI:1942680897
Name:KONG, LI (MD)
Entity Type:Individual
Prefix:
First Name:LI
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13668 ROOSEVELT AVE # 5D
Mailing Address - Street 2:
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-5510
Mailing Address - Country:US
Mailing Address - Phone:718-285-9688
Mailing Address - Fax:718-887-2861
Practice Address - Street 1:13668 ROOSEVELT AVE # 5D
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-5510
Practice Address - Country:US
Practice Address - Phone:718-285-9688
Practice Address - Fax:718-887-2861
Is Sole Proprietor?:Yes
Enumeration Date:2015-06-05
Last Update Date:2018-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY296268207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program