Basic Information
Provider Information | |||||||||
NPI: | 1346445764 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | IONG | ||||||||
FirstName: | KAKIN | ||||||||
MiddleName: | ROBERT | ||||||||
NamePrefix: | DR. | ||||||||
NameSuffix: |   | ||||||||
Credential: | M.D. | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | IONG | ||||||||
OtherFirstName: | ROBERT | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | M.D. | ||||||||
OtherLastNameType: | 5 | ||||||||
Mailing Information | |||||||||
Address1: | 474 48TH AVE APT 8G | ||||||||
Address2: |   | ||||||||
City: | LONG ISLAND CITY | ||||||||
State: | NY | ||||||||
PostalCode: | 111095610 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7024533799 | ||||||||
FaxNumber: | 7024535741 | ||||||||
Practice Location | |||||||||
Address1: | 532 1ST ST NW | ||||||||
Address2: |   | ||||||||
City: | BRITT | ||||||||
State: | IA | ||||||||
PostalCode: | 504231227 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 7024533799 | ||||||||
FaxNumber: | 7024535741 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/16/2007 | ||||||||
LastUpdateDate: | 11/30/2015 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | M | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | Y | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A112656 | CA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 258334 | NY | Y |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | 58590 | MN | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   | 207R00000X | MD-42546 | IA | N |   | Allopathic & Osteopathic Physicians | Internal Medicine |   |
No ID Information.