Individual
JEFFREY JOSEPH KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
OD
Contact information
Practice address
230 MINOR HALL MC-2020, BERKELEY, CA 94720-2020
(510) 642-2020
(510) 642-8012
Mailing address
1515 W HILLVIEW CT, GILROY, CA 95020-3753
(408) 310-1271
Taxonomy
Speciality
Code
Description
License number
State
152W00000X
Optometrist
10356
TX
152W00000X
Optometrist
Primary
34996TLG
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10356
STATE LICENSE
TX
01
—
34996TLG
STATE LICENSE
CA
05
—
426300601
—
TX
Enumeration date
07/08/2021
Last updated
08/06/2022
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