Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207N00000X | Dermatologist | 036149176 | IL |
N | 207N00000X | Dermatologist | 125067947 | IL |
NPI | 1033508817 |
---|---|
Provider Name | Betty Kong |
First Address | Chicago, IL 60611-4546 |
Second Address | Glenview, IL 60026-8039 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 15/01/2015 |
Last Update Date | 17/06/2019 |