Healthcare Provider Details

I. General information

NPI: 1528462199
Provider Name (Legal Business Name): KATHERINA FONG PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2014
Last Update Date: 06/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2310 HOMESTEAD RD
LOS ALTOS CA
94024
US

IV. Provider business mailing address

2310 HOMESTEAD RD
LOS ALTOS CA
94024-7339
US

V. Phone/Fax

Practice location:
  • Phone: 408-774-0134
  • Fax:
Mailing address:
  • Phone: 408-774-0134
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number71740
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: