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General NPI Number Information
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NPI Number | 1497622963
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Entity Type | Individual
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Provider Name | HEEDO KONG
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Gender | Male
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Dates
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Enumeration Date | 10/20/2025
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Last Update Date | 10/20/2025
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Provider Practice Location Address
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Address Line | 3301 N RIDGE RD
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-7500
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Country | US
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Telephone | 410-461-1333
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Fax | 410-461-1339
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Provider Business Mailing Address
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Address Line | 3301 N RIDGE RD
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City | ELLICOTT CITY
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State | MD
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Zip | 21043-7500
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Country | US
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Telephone | 410-461-1333
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Fax | 410-461-1339
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 23094
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License Number State | MD
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