Healthcare Provider Details

I. General information

NPI: 1831776632
Provider Name (Legal Business Name): BRONSON HIGA FONG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/26/2021
Last Update Date: 06/17/2026
Certification Date: 06/17/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6801 PARK TER STE 140
LOS ANGELES CA
90045-1543
US

IV. Provider business mailing address

1209 BLUFF DR
SLIDELL LA
70461-5081
US

V. Phone/Fax

Practice location:
  • Phone: 310-665-7200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License NumberA207206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: