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NPI Code Detail

MEDICARE: PEI ANN KONG M.D.

MEDICARE: PEI ANN KONG M.D.
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207R00000XInternal Medicine PhysicianMD418818PA
2208000000XPediatrics PhysicianMD418818PA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1912999798
Entity Type Code : Individual
Provider Name (Legal Business Name) : PEI ANN KONG M.D.
Provider Business Mailing Address
First Line : ONE MEDICAL CENTER BLVD
Second Line : SUITE 532
City : UPLAND
State : PA
Zip : 19013
Country : US
Telephone Number : 610-447-6788
Fax Number : 610-876-2407
Provider Business Practice Location Address
First Line : ONE MEDICAL CENTER BLVD
Second Line : SUITE 532
City : UPLAND
State : PA
Zip : 19013-3902
Country : US
Telephone Number : 610-447-6788
Fax Number : 610-876-2407
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/18/2005
Last Update Date : 07/08/2014

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Directions to “ PEI ANN KONG M.D.” Practice Location

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