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Individual
KONG TAN
Active
Individual
KONG TAN
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
25MA03121400
NJ
207ZP0102X
Anatomic Pathology & Clinical Pathology Physician
Primary
25MA03121400
NJ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0152871
—
NJ
01
—
221494442
TAX ID#
NJ
01
—
2406192000
AMERIHEALTH #
NJ
01
—
60014873
HORIZON NJ HEALTH #
NJ
01
—
P00247907
RR MDCR #
NJ
01
—
P3617811
OXFORD #
NJ
01
—
XK5557
HEALTHNET #
NJ
Enumeration date
06/14/2006
Last updated
01/04/2011
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