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General NPI Number Information
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NPI Number | 1063818805
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Entity Type | Individual
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Provider Name | VICKI J. KONG L.AC.
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Gender | Female
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 1254 IRVINE BLVD
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City | TUSTIN
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State | CA
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Zip | 92780-3509
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Country | US
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Telephone | 714-669-8845
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Fax | 714-669-1438
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Provider Business Mailing Address
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Address Line | 930 N SHAFFER ST
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City | ORANGE
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State | CA
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Zip | 92867-5716
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Country | US
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Telephone | 714-609-7434
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Fax | 714-771-2360
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171100000X
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Taxonomy Name | Acupuncturist
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License Number | 16314
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License Number State | CA
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