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NPI Code Detail

MEDICARE: GRACE FONG D.O.

MEDICARE: GRACE FONG D.O.
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
1207Q00000XFamily Medicine Physician20A9698CA

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
120A9698OTHERCASTATE MEDICAL LICENSE

General Provider Information

NPI Number : 1952559585
Entity Type Code : Individual
Provider Name (Legal Business Name) : GRACE FONG D.O.
Provider Business Mailing Address
First Line : 1100 LARKSPUR LANDING CIR STE 10
Second Line :
City : LARKSPUR
State : CA
Zip : 94939-1836
Country : US
Telephone Number : 415-924-1214
Fax Number : 415-924-1375
Provider Business Practice Location Address
First Line : 1100 LARKSPUR LANDING CIR STE 10
Second Line :
City : LARKSPUR
State : CA
Zip : 94939-1836
Country : US
Telephone Number : 415-924-1214
Fax Number : 415-924-1375
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/08/2008
Last Update Date : 07/07/2025

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