MEDICARE: DR. JANE 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
1	207Q00000X	Family Medicine Physician	A97227	CA

General Provider Information

NPI Number	:	1912910357
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JANE KONG M.D.

Provider Business Mailing Address
First Line	:	866 S WESTMORELAND AVE STE 101
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90005-2372
Country	:	US
Telephone Number	:	800-821-5675
Fax Number	:

Provider Business Practice Location Address
First Line	:	20627 GOLDEN SPRINGS DR STE 1B
Second Line	:
City	:	DIAMOND BAR
State	:	CA
Zip	:	91789-4815
Country	:	US
Telephone Number	:	909-480-0200
Fax Number	:	909-480-0201

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

Provider Enumeration Date	:	08/15/2006
Last Update Date	:	11/17/2024

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Directions to “ DR. JANE KONG M.D.” Practice Location

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