Provider Demographics
NPI:1295334100
Name:KONG, YIN
Entity type:Individual
Prefix:
First Name:YIN
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26 RUTGERS ST APT 8
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002-7142
Mailing Address - Country:US
Mailing Address - Phone:646-420-7330
Mailing Address - Fax:
Practice Address - Street 1:7105 3RD AVENUE, #523
Practice Address - Street 2:7105 3RD AVENUE, #52
Practice Address - City:BROOKLYN
Practice Address - State:NY
Practice Address - Zip Code:11209-1308
Practice Address - Country:US
Practice Address - Phone:718-865-9333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF309792-01363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health