Healthcare Provider Details

I. General information

NPI: 1174854863
Provider Name (Legal Business Name): MING FANG MD INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/20/2010
Last Update Date: 07/19/2019
Certification Date:
Deactivation Date: 02/22/2019
Reactivation Date: 07/19/2019

III. Provider practice location address

675 YGNACIO VALLEY RD SUITE 215
WALNUT CREEK CA
94596-3860
US

IV. Provider business mailing address

2036 SORRELWOOD CT
SAN RAMON CA
94582-5004
US

V. Phone/Fax

Practice location:
  • Phone: 925-776-7600
  • Fax:
Mailing address:
  • Phone: 510-230-8628
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA-83531
License Number StateCA

VIII. Authorized Official

Name: DR. MING FANG
Title or Position: PRESIDENT
Credential: MD
Phone: 510-230-8628