Individual
KOU KONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
504 CRESTVIEW DR S, MAPLEWOOD, MN 55119-5502
(651) 774-0306
Mailing address
504 CRESTVIEW DR S, MAPLEWOOD, MN 55119-5502
(651) 774-0306
Taxonomy
Speciality
Code
Description
License number
State
3747P1801X
Personal Care Attendant
Primary
—
—
Other
Enumeration date
05/31/2007
Last updated
07/08/2007
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