Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207V00000X | Obstetrician & Gynecologist | N/A | CA |
Y | 207VM0101X | Gynecologist - Maternal & Fetal Medicine | A107315 | CA |
NPI | 1114164449 |
---|---|
Provider Name | Alex Fong |
First Address | Orange, CA 92868-4900 |
Second Address | Newport Beach, CA 92663-3522 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2009 |
Last Update Date | 08/12/2021 |