MEDICARE: KONG GLOBAL, 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	3336C0003X	Community/Retail Pharmacy

General Provider Information

NPI Number	:	1942917919
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KONG GLOBAL, LLC

Provider Business Mailing Address
First Line	:	9601 N BEACH ST STE 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6432
Country	:	US
Telephone Number	:	817-952-1999
Fax Number	:	817-952-1932

Provider Business Practice Location Address
First Line	:	9601 N BEACH ST STE 105
Second Line	:
City	:	FORT WORTH
State	:	TX
Zip	:	76244-6432
Country	:	US
Telephone Number	:	817-952-1999
Fax Number	:	817-952-1932

Authorized Official
Title or Position	:	MANAGER
Name	:	TINA KONG
Credential	:
Telephone Number	:	817-952-1999

Provider Enumeration Date	:	10/31/2022
Last Update Date	:	10/31/2022

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Directions to “KONG GLOBAL, LLC ” Practice Location

Language	Start Address	Practice Location

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