Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208200000X | Surgeon | G130488 | CA |
Y | 208600000X | Surgeon | G130488 | CA |
N | 2086X0206X | Surgical Oncologist | 164241-1 | NY |
NPI | 1346231735 |
---|---|
Provider Name | Yuman Fong |
First Address | Los Angeles, CA 90051-0185 |
Second Address | Duarte, CA 91010-3012 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/11/2005 |
Last Update Date | 11/12/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
F22806 | (02) |