MEDICARE: DR. LILLIAN FONG MD

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	208000000X	Pediatrics Physician	88015	SC

General Provider Information

NPI Number	:	1720547706
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. LILLIAN FONG MD

Provider Business Mailing Address
First Line	:	3617 CASEY ST STE B
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2981
Country	:	US
Telephone Number	:	843-716-8300
Fax Number	:	843-716-9792

Provider Business Practice Location Address
First Line	:	3617 CASEY ST STE B
Second Line	:
City	:	LORIS
State	:	SC
Zip	:	29569-2981
Country	:	US
Telephone Number	:	843-716-8300
Fax Number	:	843-716-9792

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

Provider Enumeration Date	:	03/18/2019
Last Update Date	:	07/07/2025

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Directions to “ DR. LILLIAN FONG MD” Practice Location

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