Healthcare Provider Details

I. General information

NPI: 1225129141
Provider Name (Legal Business Name): RONALD G KONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/27/2006
Last Update Date: 10/21/2021
Certification Date: 10/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR STE A5
LAS VEGAS NV
89106-4829
US

IV. Provider business mailing address

1930 VILLAGE CENTER CIR BOX 3-532
LAS VEGAS NV
89134-6238
US

V. Phone/Fax

Practice location:
  • Phone: 702-382-3331
  • Fax: 702-382-5925
Mailing address:
  • Phone: 702-382-3331
  • Fax: 702-382-5925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8608
License Number StateNV
# 2
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number8608
License Number StateNV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: