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General NPI Number Information
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NPI Number | 1730205691
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Entity Type | Individual
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Provider Name | JOHN KONG DDS
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Gender | Male
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Dates
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Enumeration Date | 03/22/2007
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Last Update Date | 01/16/2019
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Provider Practice Location Address
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Address Line | 12510 QUEENS BLVD STE 219
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City | KEW GARDENS
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State | NY
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Zip | 11415-1506
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Country | US
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Telephone | 718-263-5991
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Fax | 718-268-0105
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Provider Business Mailing Address
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Address Line | 6738 AUSTIN ST
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City | FOREST HILLS
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State | NY
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Zip | 11375-3556
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Country | US
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Telephone | 646-483-1181
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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 | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 22DI02274200
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 1223P0300X
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Taxonomy Name | Periodontics
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License Number | 051193-1
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License Number State | NY
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