Healthcare Provider Details

I. General information

NPI: 1396828554
Provider Name (Legal Business Name): LORNA KONG-THEIN MD APC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 12/20/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 SOUTH SANTA ANITA STREET SUITE 330
SAN GABRIEL CA
91776
US

IV. Provider business mailing address

207 SOUTH SANTA ANITA STREET SUITE 330
SAN GABRIEL CA
91776
US

V. Phone/Fax

Practice location:
  • Phone: 626-458-1888
  • Fax: 626-458-2895
Mailing address:
  • Phone: 626-458-1888
  • Fax: 626-458-2895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License NumberA51913
License Number StateCA

VIII. Authorized Official

Name: LORNA KONG-THEIN
Title or Position: PRESIDENT OWNER
Credential: MD
Phone: 626-458-1888