MEDICARE: KONG T OH MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207W00000X	Ophthalmology Physician	35-04-2367-O	OH

General Provider Information

NPI Number	:	1164428199
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KONG T OH MD

Provider Business Mailing Address
First Line	:	8110 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6243
Country	:	US
Telephone Number	:	330-758-0900
Fax Number	:

Provider Business Practice Location Address
First Line	:	8110 MARKET ST
Second Line	:
City	:	YOUNGSTOWN
State	:	OH
Zip	:	44512-6243
Country	:	US
Telephone Number	:	330-758-0900
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/23/2005
Last Update Date	:	02/01/2008

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