Provider Demographics
NPI:1972705291
Name:KONG, KOU
Entity Type:Individual
Prefix:
First Name:KOU
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:504 CRESTVIEW DR S
Mailing Address - Street 2:
Mailing Address - City:MAPLEWOOD
Mailing Address - State:MN
Mailing Address - Zip Code:55119-5502
Mailing Address - Country:US
Mailing Address - Phone:651-774-0306
Mailing Address - Fax:
Practice Address - Street 1:504 CRESTVIEW DR S
Practice Address - Street 2:
Practice Address - City:MAPLEWOOD
Practice Address - State:MN
Practice Address - Zip Code:55119-5502
Practice Address - Country:US
Practice Address - Phone:651-774-0306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant