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General NPI Number Information
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NPI Number | 1174854863
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Entity Type | Organization
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Legal Business Name | MING FANG MD INC
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Dates
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Enumeration Date | 01/20/2010
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Last Update Date | 07/19/2019
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Provider Practice Location Address
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Address Line | 675 YGNACIO VALLEY RD SUITE 215
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City | WALNUT CREEK
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State | CA
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Zip | 94596-3860
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Country | US
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Telephone | 925-776-7600
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Fax |
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Provider Business Mailing Address
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Address Line | 2036 SORRELWOOD CT
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City | SAN RAMON
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State | CA
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Zip | 94582-5004
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Country | US
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Telephone | 510-230-8628
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. MING FANG
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Credential | MD
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Telephone | 510-230-8628
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RG0100X
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Taxonomy Name | Gastroenterology Physician
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License Number | A-83531
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License Number State | CA
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