Provider Demographics
NPI:1396930731
Name:KONG, WEI YEN (MD)
Entity type:Individual
Prefix:DR
First Name:WEI YEN
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3617 BRYANT AVE S
Mailing Address - Street 2:APT 101
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55409-1042
Mailing Address - Country:US
Mailing Address - Phone:612-202-0517
Mailing Address - Fax:
Practice Address - Street 1:3617 BRYANT AVE S
Practice Address - Street 2:APT 101
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55409-1042
Practice Address - Country:US
Practice Address - Phone:612-202-0517
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2007-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program