Provider Demographics
NPI:1912999798
Name:KONG, PEI ANN (MD)
Entity Type:Individual
Prefix:
First Name:PEI ANN
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:ONE MEDICAL CENTER BLVD
Mailing Address - Street 2:SUITE 532
Mailing Address - City:UPLAND
Mailing Address - State:PA
Mailing Address - Zip Code:19013
Mailing Address - Country:US
Mailing Address - Phone:610-447-6788
Mailing Address - Fax:610-876-2407
Practice Address - Street 1:ONE MEDICAL CENTER BLVD
Practice Address - Street 2:SUITE 532
Practice Address - City:UPLAND
Practice Address - State:PA
Practice Address - Zip Code:19013-3902
Practice Address - Country:US
Practice Address - Phone:610-447-6788
Practice Address - Fax:610-876-2407
Is Sole Proprietor?:No
Enumeration Date:2005-08-18
Last Update Date:2014-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD418818207R00000X, 208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
No208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY2372301Medicaid
PA001912444 0001Medicaid
NY2372301Medicaid
PA060497Medicare PIN