Doctor Name: | DR. MICHAEL SUNGJIN KONG |
NPI Number: | 1477524015 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | M.D. |
License Number: | A74427 |
Business Practice Address: | Comnavsurfor Medical Dept (code N01ma) 2841 Rendova Road San Diego, CA - 921555491 |
Business Phone Number: | 6194372860 |
Business Fax Number: | 6194372700 |
Mailing Address: | 1 Boone Rd, BREMERTON |
State: | WA |
Postal Code: | 983121894 |
Phone Number: | 3604755115 |
Fax Number: | |
NPI Enumeration Date: | 01/31/2006 |
NPI Last Update Date: | 09/17/2015 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 208D00000X |
License Number: | A74427 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | CA |
Taxonomy Type: | Allopathic & Osteopathic Physicians |
Taxonomy Classification: | General Practice |
Taxonomy Specialization: | |
Taxonomy Definition: |