Healthcare Provider Details

I. General information

NPI: 1326023482
Provider Name (Legal Business Name): YI-KONG KEUNG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: YI KONG KEUNG MD

II. Dates (important events)

Enumeration Date: 12/13/2005
Last Update Date: 01/16/2024
Certification Date: 01/16/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1411 S GARFIELD AVE STE 200
ALHAMBRA CA
91801-5024
US

IV. Provider business mailing address

1411 S GARFIELD AVE STE 200
ALHAMBRA CA
91801-5024
US

V. Phone/Fax

Practice location:
  • Phone: 626-588-2825
  • Fax: 626-588-2850
Mailing address:
  • Phone: 626-588-2825
  • Fax: 626-588-2850

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RH0003X
TaxonomyHematology & Oncology Physician
License NumberC53429
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License Number99-00565
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: