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General NPI Number Information
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NPI Number | 1316255201
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Entity Type | Organization
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Legal Business Name | PATRICK L S KONG M D A PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/14/2010
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Last Update Date | 09/17/2010
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Provider Practice Location Address
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Address Line | 1700 N ROSE AVE STE 450
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City | OXNARD
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State | CA
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Zip | 93030-7628
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Country | US
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Telephone | 805-988-1105
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Fax | 805-988-1554
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Provider Business Mailing Address
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Address Line | P.O. BOX 1540
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City | CAMARILLO
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State | CA
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Zip | 93011
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Country | US
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Telephone | 805-988-1105
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Fax | 805-988-1554
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Authorized Official
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Title or Position | OWNER
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Name | DR. PATRICK L S KONG
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Credential | MD
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Telephone | 805-988-1105
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 174400000X
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Taxonomy Name | Specialist
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License Number | A043407
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License Number State | CA
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