Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213EP1101X | Primary Podiatric Medicine | 25MD00127000 | NJ |
NPI | 1083609879 |
---|---|
Provider Name | Dr. Chau Kai Kong |
First Address | Hillsborough, NJ 08844-4526 |
Second Address | Hillsborough, NJ 08844-4526 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 17/09/2005 |
Last Update Date | 11/05/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
4695003 | (05) | NJ |
T45005 | (02) | NJ |