Provider Demographics
NPI:1023689825
Name:KONG, QINGCHUN
Entity type:Individual
Prefix:
First Name:QINGCHUN
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4343 CONCOURSE DR STE 110
Mailing Address - Street 2:
Mailing Address - City:ANN ARBOR
Mailing Address - State:MI
Mailing Address - Zip Code:48108-8400
Mailing Address - Country:US
Mailing Address - Phone:734-276-7796
Mailing Address - Fax:
Practice Address - Street 1:4343 CONCOURSE DR STE 110
Practice Address - Street 2:
Practice Address - City:ANN ARBOR
Practice Address - State:MI
Practice Address - Zip Code:48108-8400
Practice Address - Country:US
Practice Address - Phone:734-276-7796
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-07-02
Last Update Date:2021-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5402000062171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty