Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RA0001X | Advanced Heart Failure and Transplant Cardiologist | A114374 | CA |
N | 207RC0000X | Internist - Cardiovascular Disease | 243025-1 | NY |
N | 207RC0000X | Internist - Cardiovascular Disease | A 114374 | CA |
NPI | 1407863756 |
---|---|
Provider Name | Dr. Michael William Fong |
First Address | Los Angeles, CA 90031-0309 |
Second Address | Los Angeles, CA 90033-5310 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/08/2006 |
Last Update Date | 28/08/2020 |