MEDICARE: DR. RALPH FONG JR. M.D.

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	207Q00000X	Family Medicine Physician	G73942	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	:	1447290994
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. RALPH FONG JR. M.D.

Provider Business Mailing Address
First Line	:	DEPT 34929
Second Line	:	P.O. BOX 39000
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94139-0001
Country	:	US
Telephone Number	:	925-952-2828
Fax Number	:	925-952-2850

Provider Business Practice Location Address
First Line	:	2305 CAMINO RAMON
Second Line	:	SUITE 100
City	:	SAN RAMON
State	:	CA
Zip	:	94583-1396
Country	:	US
Telephone Number	:	925-837-1886
Fax Number	:	925-837-3913

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

Provider Enumeration Date	:	06/06/2006
Last Update Date	:	06/21/2012

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