Provider Demographics
NPI:1699918110
Name:KONG, MAX XIANGTIAN (MD)
Entity type:Individual
Prefix:
First Name:MAX
Middle Name:XIANGTIAN
Last Name:KONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:XIANGTIAN
Other - Middle Name:
Other - Last Name:KONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:431 PARKFAIR DR
Mailing Address - Street 2:APT. 11
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95864-7261
Mailing Address - Country:US
Mailing Address - Phone:347-855-9879
Mailing Address - Fax:
Practice Address - Street 1:2025 MORSE AVE
Practice Address - Street 2:DEPT. OF PATHOLOGY, ROOM 0487
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95825-2115
Practice Address - Country:US
Practice Address - Phone:916-973-7278
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-04-14
Last Update Date:2022-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
CAA142646207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program