Individual provider Active NPI

Kyong A Kong, DDS

  • Dentist
  • Kansas City, MO
National Provider Identifier
1831104579
Registry record updated Oct 12, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
DentistTaxonomy code 122300000X
License
2004000867 Issued in MO
Practice address
825 Euclid Ave
Kansas City, MO 64124-2323
Phone
(816) 474-4920
Fax
(816) 889-1845
NPI assigned
Jul 30, 2006
Sex
Female
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Oct 12, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Dentist 122300000X 2004000867 MO Primary

Addresses

Primary practice location

825 Euclid Ave
Kansas City, MO 64124-2323

Mailing address

825 Euclid Ave
Kansas City, MO 64124-2323
Phone (816) 474-4920

Other identifiers 2

IdentifierTypeStateIssuer
409037009MedicaidMO
C16000075OtherMOMEDICARE PTAN

Other names 1

  • Kay A Kong Other name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MO
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: No
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20151019001943 MO Practitioner - Oral Surgery 4183933922 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
2004000867MOMDDentist

Practice roles

OrganizationSpecialtyStatusNew patients
Samuel U. Rodgers Health Center, Inc CurrentSince Sep 13, 2015 Accepting new patients
Samuel U. Rodgers Health Center, Inc. Current Accepting new patients

Locations

825 Euclid Ave
Kansas City, MO 64124
Phone (816) 889-4816

811 S Business Highway 13
Ste A
Lexington, MO 64067
Phone (660) 259-3823

800 Haines
Liberty, MO 64068
Phone (816) 595-4200

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154217600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1476230400000",
    "number": "1831104579",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "825 EUCLID AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641242323",
            "telephone_number": "816-474-4920",
            "fax_number": "816-889-1845"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "825 EUCLID AVE",
            "city": "KANSAS CITY",
            "state": "MO",
            "postal_code": "641242323",
            "telephone_number": "816-474-4920",
            "fax_number": "816-889-1845"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "KONG",
        "first_name": "KYONG",
        "middle_name": "A",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2006-07-30",
        "last_updated": "2016-10-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "MO",
            "license": "2004000867",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "409037009",
            "state": "MO"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PTAN",
            "identifier": "C16000075",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KAY",
            "last_name": "KONG",
            "middle_name": "A",
            "credential": "DDS",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

Other providers in Kansas City, MO

Sources for this page

Verify at the official NPI Registry.