Healthcare Provider Details

I. General information

NPI: 1972290237
Provider Name (Legal Business Name): JASON KONG ZHOU DO
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3417 U OF A WAY
TEXARKANA AR
71854-1419
US

IV. Provider business mailing address

1601 W 40TH AVE STE 100
PINE BLUFF AR
71603-6069
US

V. Phone/Fax

Practice location:
  • Phone: 870-779-6000
  • Fax: 870-779-6055
Mailing address:
  • Phone: 870-541-6010
  • Fax: 870-541-6009

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: