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General NPI Number Information
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NPI Number | 1669391223
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Entity Type | Organization
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Legal Business Name | BRIAN W. FONG, DMD, INC.
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Dates
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Enumeration Date | 07/15/2026
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Last Update Date | 07/15/2026
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Provider Practice Location Address
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Address Line | 3401 EL CAMINO REAL
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City | ATHERTON
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State | CA
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Zip | 94027-3845
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Country | US
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Telephone | 650-474-0551
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Fax | 650-474-0553
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Provider Business Mailing Address
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Address Line | 3401 EL CAMINO REAL
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City | ATHERTON
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State | CA
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Zip | 94027-3845
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Country | US
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Telephone | 650-474-0551
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Fax | 650-474-0553
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Authorized Official
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Title or Position | DENTIST
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Name | BRIAN FONG
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Credential | DMD
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Telephone | 650-474-0551
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number |
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License Number State |
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