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General NPI Number Information
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NPI Number | 1245336809
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Entity Type | Organization
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Legal Business Name | DENNIS Y. FONG, M.D., PROFESSIONAL CORPORATION
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Dates
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Enumeration Date | 09/14/2006
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Last Update Date | 11/20/2020
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Provider Practice Location Address
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Address Line | 108 LA CASA VIA SUITE 104
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-934-2333
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Fax | 925-934-2688
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Provider Business Mailing Address
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Address Line | 108 LA CASA VIA SUITE 104
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City | WALNUT CREEK
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State | CA
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Zip | 94598
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Country | US
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Telephone | 925-934-2333
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Fax | 925-934-2688
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Authorized Official
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Title or Position | PROVIDER
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Name | DR. DENNIS YUNMING FONG
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Credential | M.D.
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Telephone | 925-934-2333
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | G83720
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License Number State | CA
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number |
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License Number State |
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