Provider Demographics
NPI:1194270801
Name:KONG, TOU SU TAYLOR
Entity type:Individual
Prefix:
First Name:TOU
Middle Name:SU TAYLOR
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 1:33 BATTLE CREEK PL
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55119-4909
Mailing Address - Country:US
Mailing Address - Phone:651-263-2866
Mailing Address - Fax:
Practice Address - Street 1:33 BATTLE CREEK PL
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55119-4909
Practice Address - Country:US
Practice Address - Phone:651-263-2866
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-23
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172A00000XOther Service ProvidersDriver