Healthcare Provider Details

I. General information

NPI: 1346445764
Provider Name (Legal Business Name): KAKIN ROBERT IONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: ROBERT IONG M.D.

II. Dates (important events)

Enumeration Date: 06/16/2007
Last Update Date: 11/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

532 1ST ST NW
BRITT IA
50423-1227
US

IV. Provider business mailing address

474 48TH AVE APT 8G
LONG ISLAND CITY NY
11109-5610
US

V. Phone/Fax

Practice location:
  • Phone: 702-453-3799
  • Fax: 702-453-5741
Mailing address:
  • Phone: 702-453-3799
  • Fax: 702-453-5741

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA112656
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number258334
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number58590
License Number StateMN
# 4
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberMD-42546
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: