Healthcare Provider Details

I. General information

NPI: 1235609413
Provider Name (Legal Business Name): LEO L FONG CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2018
Last Update Date: 04/13/2026
Certification Date: 04/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3120 WILLOW AVE STE 101
CLOVIS CA
93612-4714
US

IV. Provider business mailing address

PO BOX 5337
FRESNO CA
93755-5337
US

V. Phone/Fax

Practice location:
  • Phone: 559-721-4910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2086S0129X
TaxonomyVascular Surgery Physician
License Number
License Number State

VIII. Authorized Official

Name: ZACHARY SMITH
Title or Position: PHY. SVS. PROJECT MANAGER
Credential:
Phone: 559-721-4910