Healthcare Provider Details

I. General information

NPI: 1578853180
Provider Name (Legal Business Name): SOPHIA FONG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/15/2011
Last Update Date: 07/29/2026
Certification Date: 07/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

103 N GARFIELD AVE STE G
ALHAMBRA CA
91801-3578
US

IV. Provider business mailing address

103 N GARFIELD AVE
ALHAMBRA CA
91801-3555
US

V. Phone/Fax

Practice location:
  • Phone: 626-800-1230
  • Fax: 626-576-2352
Mailing address:
  • Phone: 626-800-1230
  • Fax: 626-576-2352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA21424
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: