Provider Demographics
NPI:1477805323
Name:YUE-KONG AU MD LLC
Entity type:Organization
Organization Name:YUE-KONG AU MD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:YUE KONG
Authorized Official - Middle Name:
Authorized Official - Last Name:AU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:318-742-3399
Mailing Address - Street 1:2539 VIKING DR
Mailing Address - Street 2:STE 103
Mailing Address - City:BOSSIER CITY
Mailing Address - State:LA
Mailing Address - Zip Code:71111-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2539 VIKING DR
Practice Address - Street 2:STE 103
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71111-1611
Practice Address - Country:US
Practice Address - Phone:318-742-3399
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-02
Last Update Date:2012-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1370096Medicaid
LA1300150001Medicare NSC
LA1370096Medicaid
B64568Medicare UPIN