Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 1223G0001X | General Practice | 27271 | TX |
N | 213EG0000X | General Practice | 27271 | TX |
Y | 1223P0221X | Pediatric Dentist | 64577 | CA |
NPI | 1013297795 |
---|---|
Provider Name | Dr. Namie Kong |
First Address | Carson, CA 90746-3701 |
Second Address | Carson, CA 90746-3701 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/08/2011 |
Last Update Date | 23/11/2015 |