MEDICARE: BUMIN KONG

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	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	A178290	CA
2	207P00000X	Emergency Medicine Physician	A178290	CA

General Provider Information

NPI Number	:	1497382220
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BUMIN KONG

Provider Business Mailing Address
First Line	:	1001 NEWBURY RD
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91320-6434
Country	:	US
Telephone Number	:	805-379-2322
Fax Number	:

Provider Business Practice Location Address
First Line	:	558 SAINT CHARLES DR STE 200
Second Line	:
City	:	THOUSAND OAKS
State	:	CA
Zip	:	91360-3968
Country	:	US
Telephone Number	:	805-379-2322
Fax Number	:

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

Provider Enumeration Date	:	03/23/2020
Last Update Date	:	04/02/2026

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Directions to “ BUMIN KONG ” Practice Location

Language	Start Address	Practice Location

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