Provider Demographics
NPI:1912910357
Name:KONG, JANE (MD)
Entity type:Individual
Prefix:DR
First Name:JANE
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:866 S WESTMORELAND AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-2372
Mailing Address - Country:US
Mailing Address - Phone:800-821-5675
Mailing Address - Fax:
Practice Address - Street 1:20627 GOLDEN SPRINGS DR STE 1B
Practice Address - Street 2:
Practice Address - City:DIAMOND BAR
Practice Address - State:CA
Practice Address - Zip Code:91789-4815
Practice Address - Country:US
Practice Address - Phone:909-480-0200
Practice Address - Fax:909-480-0201
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2024-11-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA97227207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine