Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207KA0200X | Allergist | A84509 | CA |
Y | 207R00000X | Internist | A84509 | CA |
Y | 111NI0900X | Internist | A84509 | CA |
NPI | 1366426470 |
---|---|
Provider Name | Dr. James Kong |
First Address | Alameda, CA 94501-0173 |
Second Address | Alameda, CA 94501-5762 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/12/2005 |
Last Update Date | 10/12/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
I30803 | (02) | CA |