Provider Demographics
NPI:1982740619
Name:KONG, CELIA (PA-C)
Entity Type:Individual
Prefix:MISS
First Name:CELIA
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:807 PROSPECT AVE APT 206
Mailing Address - Street 2:
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2449
Mailing Address - Country:US
Mailing Address - Phone:818-395-8201
Mailing Address - Fax:
Practice Address - Street 1:200 N ROBERTSON BLVD STE 202
Practice Address - Street 2:
Practice Address - City:BEVERLY HILLS
Practice Address - State:CA
Practice Address - Zip Code:90211-6002
Practice Address - Country:US
Practice Address - Phone:310-385-3300
Practice Address - Fax:310-385-3366
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPA 18474363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant