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General NPI Number Information
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NPI Number | 1396879672
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Entity Type | Individual
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Provider Name | JESSE KONG MMS, PA-C
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Gender | Male
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Dates
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Enumeration Date | 03/16/2007
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Last Update Date | 03/05/2025
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Provider Practice Location Address
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Address Line | 3551 HIGHLAND AVE STE 200A
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City | DOWNERS GROVE
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State | IL
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Zip | 60515-2100
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Country | US
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Telephone | 844-376-3876
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Fax | 630-929-0633
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Provider Business Mailing Address
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Address Line | 29373 NETWORK PL
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City | CHICAGO
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State | IL
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Zip | 60673-1293
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Country | US
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Telephone | 847-390-5900
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Fax |
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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 | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | 085-002627
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License Number State | IL
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