Healthcare Provider Details

I. General information

NPI: 1316897903
Provider Name (Legal Business Name): DR. KONG MENG VANG
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4250 E TULARE ST
FRESNO CA
93702-3037
US

IV. Provider business mailing address

5931 E PITT AVE
FRESNO CA
93727-6063
US

V. Phone/Fax

Practice location:
  • Phone: 559-253-5200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TS0200X
TaxonomySchool Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: