Provider Demographics
NPI:1871108936
Name:KONG, SALLY SING MING
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:SING MING
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 1:2430 ALEMANY BLVD
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94112-3609
Mailing Address - Country:US
Mailing Address - Phone:415-316-8980
Mailing Address - Fax:
Practice Address - Street 1:5630 COTTLE RD
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95123-3696
Practice Address - Country:US
Practice Address - Phone:408-600-3722
Practice Address - Fax:408-600-3732
Is Sole Proprietor?:No
Enumeration Date:2020-09-14
Last Update Date:2020-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH82854183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist