Healthcare Provider Details

I. General information

NPI: 1396837837
Provider Name (Legal Business Name): KIN CHING KONG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/29/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2835 N. SHEFFIELD SUITE 403
CHICAGO IL
60657
US

IV. Provider business mailing address

2835 N. SHEFFIELD SUITE 403
CHICAGO IL
60657
US

V. Phone/Fax

Practice location:
  • Phone: 773-391-8209
  • Fax: 773-244-9504
Mailing address:
  • Phone: 773-391-8209
  • Fax: 773-244-9504

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: