Provider Demographics
NPI:1043419963
Name:FONG, WESLEY KWOK (DDS)
Entity Type:Individual
Prefix:DR
First Name:WESLEY
Middle Name:KWOK
Last Name:FONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2525 K ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5114
Mailing Address - Country:US
Mailing Address - Phone:916-448-6826
Mailing Address - Fax:916-448-9249
Practice Address - Street 1:2525 K ST
Practice Address - Street 2:SUITE 108
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5114
Practice Address - Country:US
Practice Address - Phone:916-448-6826
Practice Address - Fax:916-448-9249
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-11
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA349581223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice