Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207VG0400X | Gynecologist | C42949 | CA |
NPI | 1033174974 |
---|---|
Provider Name | Mr. Hon Fong |
First Address | Oakland, CA 94609-3113 |
Second Address | Oakland, CA 94609-3113 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/04/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00C429490 | (05) | CA |
D56317 | (02) |