Provider Demographics
NPI:1881798056
Name:KONG, THOMAS Q JR (MD)
Entity type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:Q
Last Name:KONG
Suffix:JR
Gender:M
Credentials:MD
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Mailing Address - Street 1:3400 DATA DR
Mailing Address - Street 2:
Mailing Address - City:RANCHO CORDOVA
Mailing Address - State:CA
Mailing Address - Zip Code:95670-7956
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1700 N ROSE AVE STE 350
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7627
Practice Address - Country:US
Practice Address - Phone:805-200-3225
Practice Address - Fax:805-200-3230
Is Sole Proprietor?:No
Enumeration Date:2006-09-11
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG83838207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83838OtherSTATE OF CA
CA00G838380Medicaid
CA00G838380Medicaid
G45854Medicare UPIN
CAG45854Medicare UPIN