Provider Demographics
NPI:1447308002
Name:KONG, PATRICK LUNG-SUEN (MD)
Entity type:Individual
Prefix:DR
First Name:PATRICK
Middle Name:LUNG-SUEN
Last Name:KONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1540
Mailing Address - Street 2:
Mailing Address - City:CAMARILLO
Mailing Address - State:CA
Mailing Address - Zip Code:93011-1540
Mailing Address - Country:US
Mailing Address - Phone:805-988-1105
Mailing Address - Fax:805-988-1554
Practice Address - Street 1:1700 N ROSE AVE STE 450
Practice Address - Street 2:
Practice Address - City:OXNARD
Practice Address - State:CA
Practice Address - Zip Code:93030-7628
Practice Address - Country:US
Practice Address - Phone:805-988-1105
Practice Address - Fax:805-988-1554
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-08
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA0434072084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA043407OtherSTATE LICENSE
CABL0899813OtherDEA #
CABL0899813OtherDEA #
CAB97039Medicare UPIN