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General NPI Number Information
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NPI Number | 1285019687
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Entity Type | Individual
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Provider Name | CHRISTOPHER YOON KONG M.D.
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Gender | Male
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Dates
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Enumeration Date | 07/27/2015
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 444 S SAN VICENTE BLVD STE 901
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City | LOS ANGELES
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State | CA
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Zip | 90048-4174
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Country | US
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Telephone | 310-423-9779
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Fax | 310-423-9773
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Provider Business Mailing Address
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Address Line | 444 S SAN VICENTE BLVD STE 901
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City | LOS ANGELES
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State | CA
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Zip | 90048-4174
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Country | US
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Telephone | 323-423-9779
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Fax | 323-423-9773
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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 | 207XS0117X
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Taxonomy Name | Orthopaedic Surgery of the Spine Physician
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License Number | A141106
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License Number State | CA
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