MEDICARE: DR. DOUGLAS YEE FONG D.D.S.

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	1223G0001X	General Practice Dentistry	26848	CA

General Provider Information

NPI Number	:	1710949136
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DOUGLAS YEE FONG D.D.S.

Provider Business Mailing Address
First Line	:	3031 W MARCH LN
Second Line	:	SUITE 340
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-957-8080
Fax Number	:

Provider Business Practice Location Address
First Line	:	3031 W MARCH LN
Second Line	:	SUITE 340
City	:	STOCKTON
State	:	CA
Zip	:	95219-6500
Country	:	US
Telephone Number	:	209-957-8080
Fax Number	:

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

Provider Enumeration Date	:	04/03/2006
Last Update Date	:	10/28/2013

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