Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RR0500X | Rheumatology | G49383 | CA |
NPI | 1093893695 |
---|---|
Provider Name | Jeffrey S. Fong |
First Address | Oakland, CA 94612-3429 |
Second Address | San Francisco, CA 94115-3357 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/11/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G493830 | (05) | CA |
D36116 | (02) |