Provider Demographics
NPI:1790862993
Name:KONG, SHEENA XINNA (MD)
Entity type:Individual
Prefix:
First Name:SHEENA
Middle Name:XINNA
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 1:1199 BUSH STREET
Mailing Address - Street 2:SUITE 400
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109
Mailing Address - Country:US
Mailing Address - Phone:415-673-7600
Mailing Address - Fax:415-673-8065
Practice Address - Street 1:1199 BUSH STREET
Practice Address - Street 2:SUITE 400
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109
Practice Address - Country:US
Practice Address - Phone:415-673-7600
Practice Address - Fax:415-673-8065
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2008-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA75253207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
110243772OtherMEDICARE RR
CA00A752530Medicaid
CA00A752530Medicaid
CA00A752530Medicare PIN