Provider Demographics
NPI:1538637038
Name:KONG, YINI
Entity type:Individual
Prefix:
First Name:YINI
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 2ND ST APT 1910
Mailing Address - Street 2:
Mailing Address - City:JERSEY CITY
Mailing Address - State:NJ
Mailing Address - Zip Code:07302-4907
Mailing Address - Country:US
Mailing Address - Phone:253-230-9071
Mailing Address - Fax:973-705-3148
Practice Address - Street 1:201 LYONS AVE # L5
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NJ
Practice Address - Zip Code:07112-2027
Practice Address - Country:US
Practice Address - Phone:973-926-7280
Practice Address - Fax:973-705-3148
Is Sole Proprietor?:No
Enumeration Date:2018-11-02
Last Update Date:2024-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY382935363LP0200X
NJ26NJ14871300363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics