MEDICARE: YUE-KONG AU MD LLC

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

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1477805323
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	YUE-KONG AU MD LLC

Provider Business Mailing Address
First Line	:	2539 VIKING DR
Second Line	:	STE 103
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-1611
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2539 VIKING DR
Second Line	:	STE 103
City	:	BOSSIER CITY
State	:	LA
Zip	:	71111-1611
Country	:	US
Telephone Number	:	318-742-3399
Fax Number	:

Authorized Official
Title or Position	:	OWNER/PRACTITIONER
Name	:	YUE KONG AU
Credential	:	MD
Telephone Number	:	318-742-3399

Provider Enumeration Date	:	10/02/2012
Last Update Date	:	10/02/2012

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