Provider Demographics
NPI:1487813697
Name:KONG, CHRISTA (PA)
Entity type:Individual
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First Name:CHRISTA
Middle Name:
Last Name:KONG
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Gender:F
Credentials:PA
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Mailing Address - Street 1:2855 MITCHELL DR
Mailing Address - Street 2:SUITE 223
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-1600
Mailing Address - Country:US
Mailing Address - Phone:925-975-5944
Mailing Address - Fax:925-975-5943
Practice Address - Street 1:365 HAWTHORNE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3107
Practice Address - Country:US
Practice Address - Phone:510-452-1345
Practice Address - Fax:510-452-1102
Is Sole Proprietor?:No
Enumeration Date:2008-06-03
Last Update Date:2010-08-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAPA19710363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant