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NPI Code Detail

MEDICARE: MR. MICHAEL FONG

MEDICARE: MR. MICHAEL 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
1171M00000XCase Manager/Care Coordinator

General Provider Information

NPI Number : 1871634311
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MICHAEL FONG
Provider Business Mailing Address
First Line : 310 8TH ST STE 201
Second Line :
City : OAKLAND
State : CA
Zip : 94607-6527
Country : US
Telephone Number : 510-869-6019
Fax Number :
Provider Business Practice Location Address
First Line : 310 8TH ST STE 201
Second Line :
City : OAKLAND
State : CA
Zip : 94607-6527
Country : US
Telephone Number : 510-869-6019
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/09/2007
Last Update Date : 11/26/2007

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