Healthcare Provider Details

I. General information

NPI: 1366520199
Provider Name (Legal Business Name): MING FANG MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/01/2006
Last Update Date: 01/04/2012
Certification Date:
Deactivation Date:
Reactivation Date:

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:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RG0100X
TaxonomyGastroenterology Physician
License NumberA83531
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: