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General NPI Number Information
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NPI Number | 1255536173
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Entity Type | Organization
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Legal Business Name | EMERYVILLE MULTISPECIALTY MEDICAL GROUP PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 06/20/2007
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Last Update Date | 12/07/2012
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Provider Practice Location Address
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Address Line | 501 S SHORE CTR W SUITE 103C
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City | ALAMEDA
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State | CA
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Zip | 94501-5762
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Country | US
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Telephone | 510-769-1118
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Fax | 510-769-1119
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Provider Business Mailing Address
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Address Line | PO BOX 1560
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City | ALAMEDA
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State | CA
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Zip | 94501-0173
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Country | US
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Telephone | 510-769-1118
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Fax | 510-769-1119
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JAMES S KONG
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Credential | M.D.
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Telephone | 510-769-1118
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 202C00000X
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Taxonomy Name | Independent Medical Examiner Physician
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License Number | A76128
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207K00000X
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Taxonomy Name | Allergy & Immunology Physician
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License Number | A84509
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License Number State | CA
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Taxonomy #3
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | A76128
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License Number State | CA
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Taxonomy #4
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | A84509
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License Number State | CA
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