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NPI Code Detail

MEDICARE: DR. JAMES HO-MING KONG M.D.

MEDICARE: DR. JAMES HO-MING KONG M.D.
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
1208600000XSurgery Physician52479MN
22086S0102XSurgical Critical Care Physician52479MN
32086S0122XPlastic and Reconstructive Surgery Physician65902WI
42086S0122XPlastic and Reconstructive Surgery Physician52479MN

General Provider Information

NPI Number : 1518145051
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. JAMES HO-MING KONG M.D.
Provider Business Mailing Address
First Line : 8170 33RD AVE S # MS 21110Q
Second Line :
City : BLOOMINGTON
State : MN
Zip : 55425-4516
Country : US
Telephone Number :
Fax Number : 952-993-3611
Provider Business Practice Location Address
First Line : 5400 EXCELSIOR BLVD
Second Line :
City : ST LOUIS PARK
State : MN
Zip : 55416-2913
Country : US
Telephone Number : 952-993-3150
Fax Number : 952-993-3611
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2008
Last Update Date : 07/02/2021

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