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General NPI Number Information
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NPI Number | 1790768554
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Entity Type | Individual
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Provider Name | KATHERINE KWOK-MEI FONG M.D.
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Gender | Female
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Dates
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Enumeration Date | 11/25/2005
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Last Update Date | 02/23/2012
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Provider Practice Location Address
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Address Line | 1901 VETERANS MEMORIAL DRIVE CENTRAL TEXAS VETERANS HEALTHCARE - AMBULATORY CARE
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City | TEMPLE
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State | TX
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Zip | 76504
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Country | US
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Telephone | 254-742-4995
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Fax | 254-742-4681
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Provider Business Mailing Address
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Address Line | 112 BELLA VIS
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City | GEORGETOWN
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State | TX
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Zip | 78633-4496
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Country | US
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Telephone | 254-742-4995
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Fax | 254-742-4681
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207R00000X
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Taxonomy Name | Internal Medicine Physician
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License Number | 78005
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License Number State | MA
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