1326023482 NPI number — YI-KONG KEUNG MD

Table of content: YI-KONG KEUNG MD (NPI 1326023482)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1326023482 NPI number — YI-KONG KEUNG MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
KEUNG
Provider First Name:
YI-KONG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
KEUNG
Provider Other First Name:
YI
Provider Other Middle Name:
KONG
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
MD
Provider Other Last Name Type Code:
5

NPI Number Information

NPI Number:
1326023482
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/16/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1411 S GARFIELD AVE STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ALHAMBRA
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
91801-5024
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
626-588-2825
Provider Business Mailing Address Fax Number:
626-588-2850

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1411 S GARFIELD AVE STE 200
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ALHAMBRA
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
91801-5024
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
626-588-2825
Provider Business Practice Location Address Fax Number:
626-588-2850
Provider Enumeration Date:
12/13/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RH0003X , with the licence number:  C53429 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 207RX0202X , with the licence number: 99-00565 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 1802827000 , issued by the state of ( WV ) . This identifiers is of the category "MEDICAID".
  • Identifier: 91604 . This is a "MEDCOST" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: GR0092870 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1326023482 , issued by the state of ( CA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 7819435 . This is a "AETNA" identifier . This identifiers is of the category "OTHER".
  • Identifier: Q0056G , issued by the state of ( SC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 6003214 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1233G . This is a "BCBS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 31638 . This is a "PARTNERS" identifier , issued by the state of ( NC ) . This identifiers is of the category "OTHER".
  • Identifier: 891233G , issued by the state of ( NC ) . This identifiers is of the category "MEDICAID".




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