Healthcare Provider Details

I. General information

NPI: 1497275085
Provider Name (Legal Business Name): KONG DU
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20406 REDWOOD RD STE A
CASTRO VALLEY CA
94546-4317
US

IV. Provider business mailing address

20406 REDWOOD RD STE A
CASTRO VALLEY CA
94546-4317
US

V. Phone/Fax

Practice location:
  • Phone: 510-731-0888
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code247200000X
TaxonomyOther Technician
License Number
License Number State

VIII. Authorized Official

Name: MS. CYNTHIA DU
Title or Position: CO-OWNER
Credential:
Phone: 510-676-3272