Healthcare Provider Details

I. General information

NPI: 1144261140
Provider Name (Legal Business Name): GINNY FONG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/09/2006
Last Update Date: 07/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 CONSTITUTION BLVD FLOOR ONE, SUITE 101 - 105
SALINAS CA
93906-3127
US

IV. Provider business mailing address

559 E ALISAL ST SUITE 201
SALINAS CA
93905-2516
US

V. Phone/Fax

Practice location:
  • Phone: 831-769-8660
  • Fax: 831-769-8655
Mailing address:
  • Phone: 831-769-1304
  • Fax: 831-757-0291

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License NumberG53687
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: