Provider Demographics
NPI:1427072909
Name:HE, KONGYUAN (MD)
Entity type:Individual
Prefix:
First Name:KONGYUAN
Middle Name:
Last Name:HE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5601 DE SOTO AVE
Mailing Address - Street 2:DEPT OF ANESTHESIOLOGY
Mailing Address - City:WOODLAND HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91367-6701
Mailing Address - Country:US
Mailing Address - Phone:818-719-4757
Mailing Address - Fax:818-995-3490
Practice Address - Street 1:5601 DE SOTO AVE
Practice Address - Street 2:DEPT OF ANESTHESIOLOGY
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91367-6701
Practice Address - Country:US
Practice Address - Phone:818-719-4757
Practice Address - Fax:818-995-3490
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61934207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A619340Medicaid
CA00A619341OtherBLUE SHIELD
G91913Medicare UPIN
CAA61934Medicare ID - Type Unspecified