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General NPI Number Information
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NPI Number | 1235407719
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Entity Type | Organization
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Legal Business Name | GARY KONG MD MPH INC
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Dates
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Enumeration Date | 12/12/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 3808 W RIVERSIDE DR #406
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City | BURBANK
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State | CA
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Zip | 91505-4325
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Country | US
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Telephone | 818-563-1449
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Fax | 818-563-1049
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Provider Business Mailing Address
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Address Line | 10061 RIVERSIDE DR #362
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City | TOLUCA LAKE
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State | CA
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Zip | 91602-2560
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Country | US
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Telephone | 818-563-1449
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Fax | 818-563-1049
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. GARY KONG
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Credential | M.D.
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Telephone | 818-563-1449
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RP1001X
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Taxonomy Name | Pulmonary Disease Physician
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License Number | A51276
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License Number State | CA
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