Healthcare Provider Details

I. General information

NPI: 1215495601
Provider Name (Legal Business Name): MORGAN FONG
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2019
Last Update Date: 03/03/2024
Certification Date: 03/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

168 ARBUSTO CIR
SACRAMENTO CA
95831-4560
US

IV. Provider business mailing address

168 ARBUSTO CIR
SACRAMENTO CA
95831-4560
US

V. Phone/Fax

Practice location:
  • Phone: 916-475-9154
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code111N00000X
TaxonomyChiropractor
License NumberDC36680
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code2255A2300X
TaxonomyAthletic Trainer
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: