MEDICARE: AIDAN DAVID LUM 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
1	207R00000X	Internal Medicine Physician	MD2024-0345	NM
2	390200000X	Student in an Organized Health Care Education/Training Program

General Provider Information

NPI Number	:	1982274064
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AIDAN DAVID LUM KONG M.D.

Provider Business Mailing Address
First Line	:	9228 MEDICAL PLAZA DRIVE
Second Line	:
City	:	CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-797-7000
Fax Number	:

Provider Business Practice Location Address
First Line	:	9330 MEDICAL PLAZA DR
Second Line	:
City	:	NORTH CHARLESTON
State	:	SC
Zip	:	29406
Country	:	US
Telephone Number	:	843-797-7000
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/30/2021
Last Update Date	:	06/16/2026

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