Basic Information
| Provider Information | |||||||||
| NPI: | 1891013603 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | KONG | ||||||||
| FirstName: | HEATHER | ||||||||
| MiddleName: | M | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8500, LOCKBOX 7642 | ||||||||
| Address2: | SHRINERS HOSPITAL FOR CHILDREN PORTLAND | ||||||||
| City: | PHILADELPHIA | ||||||||
| State: | PA | ||||||||
| PostalCode: | 191787642 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8132818115 | ||||||||
| FaxNumber: | 8132818656 | ||||||||
| Practice Location | |||||||||
| Address1: | 3101 SW SAM JACKSON PARK RD | ||||||||
| Address2: | SHRINERS HOSPITAL FOR CHILDREN PORTLAND | ||||||||
| City: | PORTLAND | ||||||||
| State: | OR | ||||||||
| PostalCode: | 972393009 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5032213424 | ||||||||
| FaxNumber: | 5032213490 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2010 | ||||||||
| LastUpdateDate: | 03/19/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207X00000X | 2015005953 | MO | N | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | 207XP3100X | MD179003 | OR | Y | Allopathic & Osteopathic Physicians | Orthopaedic Surgery | Pediatric Orthopaedic Surgery |
No ID Information.