Provider Demographics
NPI:1801081260
Name:KONG, SOPHIA (PHD)
Entity type:Individual
Prefix:MISS
First Name:SOPHIA
Middle Name:
Last Name:KONG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:176 S ORANGE GROVE BLVD APT 231
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-1771
Mailing Address - Country:US
Mailing Address - Phone:323-702-3936
Mailing Address - Fax:
Practice Address - Street 1:176 S ORANGE GROVE BLVD APT 231
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-1771
Practice Address - Country:US
Practice Address - Phone:323-702-3936
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-10
Last Update Date:2014-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY25298103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical