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NPI Code Detail

MEDICARE: STACEY T FONG

MEDICARE: STACEY T FONG
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
1237600000XAudiologist-Hearing Aid FitterAU2439CA
2237700000XHearing Instrument SpecialistHA7005CA

General Provider Information

NPI Number : 1801832894
Entity Type Code : Individual
Provider Name (Legal Business Name) : STACEY T FONG
Provider Business Mailing Address
First Line : 333 S BEAUDRY AVE FL 17
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-5105
Country : US
Telephone Number : 818-654-3573
Fax Number :
Provider Business Practice Location Address
First Line : 333 S BEAUDRY AVE FL 17
Second Line :
City : LOS ANGELES
State : CA
Zip : 90017-5105
Country : US
Telephone Number : 818-654-3573
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/20/2006
Last Update Date : 05/04/2026

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Directions to “ STACEY T FONG ” Practice Location

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