Healthcare Provider Details

I. General information

NPI: 1316255201
Provider Name (Legal Business Name): PATRICK L S KONG M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/14/2010
Last Update Date: 09/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 N ROSE AVE STE 450
OXNARD CA
93030-7628
US

IV. Provider business mailing address

P.O. BOX 1540
CAMARILLO CA
93011
US

V. Phone/Fax

Practice location:
  • Phone: 805-988-1105
  • Fax: 805-988-1554
Mailing address:
  • Phone: 805-988-1105
  • Fax: 805-988-1554

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberA043407
License Number StateCA

VIII. Authorized Official

Name: DR. PATRICK L S KONG
Title or Position: OWNER
Credential: MD
Phone: 805-988-1105