MEDICARE: HANLON JOE FONG MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician	G32167	CA
2	207RN0300X	Nephrology Physician	G32167	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1184607970
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HANLON JOE FONG MD

Provider Business Mailing Address
First Line	:	2000 VAN NESS AVE
Second Line	:	SUITE 605
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3023
Country	:	US
Telephone Number	:	415-441-6120
Fax Number	:	415-441-3858

Provider Business Practice Location Address
First Line	:	2000 VAN NESS AVE
Second Line	:	SUITE 605
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94109-3023
Country	:	US
Telephone Number	:	415-441-6120
Fax Number	:	415-441-3858

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/25/2005
Last Update Date	:	01/11/2013

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