MEDICARE: GEMINI HEALTHCARE, INC.

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	A63227	CA

General Provider Information

NPI Number	:	1710163423
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GEMINI HEALTHCARE, INC.

Provider Business Mailing Address
First Line	:	2345 BALBOA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-2912
Country	:	US
Telephone Number	:	415-752-7141
Fax Number	:	415-751-6814

Provider Business Practice Location Address
First Line	:	2345 BALBOA ST
Second Line	:
City	:	SAN FRANCISCO
State	:	CA
Zip	:	94121-2912
Country	:	US
Telephone Number	:	415-752-7141
Fax Number	:	415-751-6814

Authorized Official
Title or Position	:	PHYSICIAN/OWNER
Name	:	DR. MEI-LING ELIZABETH FONG
Credential	:	MD
Telephone Number	:	415-752-7141

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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