MEDICARE: MINCH K FONG M.D.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207RH0003X	Hematology & Oncology Physician	G70910	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1407849284
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MINCH K FONG M.D.

Provider Business Mailing Address
First Line	:	24953 PASEO DE VALENCIA
Second Line	:	#25B
City	:	LAGUNA HILLS
State	:	CA
Zip	:	92653-4342
Country	:	US
Telephone Number	:	949-770-8168
Fax Number	:	949-770-2991

Provider Business Practice Location Address
First Line	:	27800 MEDICAL CENTER RD
Second Line	:	#304
City	:	MISSION VIEJO
State	:	CA
Zip	:	92691-6410
Country	:	US
Telephone Number	:	949-770-8168
Fax Number	:	949-770-2991

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/26/2005
Last Update Date	:	07/08/2007

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