Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208100000X | Physical Medicine & Rehabilitation Doctor | 25MA06160200 | NJ |
N | 2081P2900X | Pain Medicine | 25MA06160200 | NJ |
NPI | 1134117419 |
---|---|
Provider Name | Yekyung Kong |
First Address | Mechanicsburg, PA 17055-4325 |
Second Address | West Orange, NJ 07052-1424 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 11/10/2005 |
Last Update Date | 10/03/2011 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0051055 | (05) | NJ |