Provider Demographics
NPI:1811121155
Name:KONG, YUAN (MD)
Entity type:Individual
Prefix:
First Name:YUAN
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 1:564 1ST AVE
Mailing Address - Street 2:UNIT 20Y
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10016-6482
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:564 1ST AVE
Practice Address - Street 2:UNIT 20Y
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10016-6482
Practice Address - Country:US
Practice Address - Phone:646-964-5934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-05-13
Last Update Date:2009-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program