Healthcare Provider Details

I. General information

NPI: 1386814762
Provider Name (Legal Business Name): RONALD G KONG M D A PROFESSIONAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2008
Last Update Date: 01/29/2025
Certification Date: 01/29/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 S RANCHO DR SUITE A-5
LAS VEGAS NV
89106-4828
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 TaxonomyY
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number8608
License Number StateNV

VIII. Authorized Official

Name: DR. RONALD G KONG
Title or Position: OWNER
Credential: M.D.
Phone: 702-382-3331