Provider Demographics
NPI:1831213438
Name:BONG, HENRY KAH MIN (MD)
Entity type:Individual
Prefix:DR
First Name:HENRY
Middle Name:KAH MIN
Last Name:BONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:500 OSBORNE RD
Mailing Address - Street 2:#110
Mailing Address - City:FRIDLEY
Mailing Address - State:MN
Mailing Address - Zip Code:55432
Mailing Address - Country:US
Mailing Address - Phone:763-236-2075
Mailing Address - Fax:763-236-2080
Practice Address - Street 1:500 OSBORNE RD
Practice Address - Street 2:#110
Practice Address - City:FRIDLEY
Practice Address - State:MN
Practice Address - Zip Code:55432
Practice Address - Country:US
Practice Address - Phone:763-236-2075
Practice Address - Fax:763-236-2080
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-19
Last Update Date:2025-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI22670020207V00000X
MN26086207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI1831213438Medicaid
MN428302300Medicaid
MN160000514Medicare ID - Type Unspecified