Individual
JESSE KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MMS, PA-C
Contact information
Practice address
3551 HIGHLAND AVE STE 200A, DOWNERS GROVE, IL 60515-2100
(844) 376-3876
(630) 929-0633
Mailing address
29373 NETWORK PL, CHICAGO, IL 60673-1293
(847) 390-5900
Taxonomy
Speciality
Code
Description
License number
State
363AS0400X
Surgical Physician Assistant
Primary
085-002627
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
206147
MEDICARE PTAN (GROUP)
IL
01
—
206147256
MEDICARE PTAN (INDIVIDUAL)
IL
Enumeration date
03/16/2007
Last updated
03/05/2025
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