Healthcare Provider Details

I. General information

NPI: 1114164449
Provider Name (Legal Business Name): ALEX FONG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/08/2009
Last Update Date: 12/08/2021
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

361 HOSPITAL RD STE 229
NEWPORT BEACH CA
92663-3522
US

IV. Provider business mailing address

770 THE CITY DR S SUITE 4000
ORANGE CA
92868-4900
US

V. Phone/Fax

Practice location:
  • Phone: 949-515-7861
  • Fax: 949-515-7846
Mailing address:
  • Phone: 800-463-6628
  • Fax: 714-620-3008

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberN/A
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code207VM0101X
TaxonomyMaternal & Fetal Medicine Physician
License NumberA107315
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: