Provider Demographics
NPI:1043423916
Name:FONG, TERRY A (ND)
Entity Type:Individual
Prefix:
First Name:TERRY
Middle Name:A
Last Name:FONG
Suffix:
Gender:F
Credentials:ND
Other - Prefix:
Other - First Name:TERRY
Other - Middle Name:A
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NMD, OT
Mailing Address - Street 1:PO BOX 1318
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95812-1318
Mailing Address - Country:US
Mailing Address - Phone:949-844-7374
Mailing Address - Fax:949-272-5847
Practice Address - Street 1:26700 TOWNE CENTRE DR STE 115
Practice Address - Street 2:
Practice Address - City:FOOTHILL RANCH
Practice Address - State:CA
Practice Address - Zip Code:92610-2843
Practice Address - Country:US
Practice Address - Phone:949-844-7374
Practice Address - Fax:949-272-5847
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2024-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
175F00000X
AZ11-1271175F00000X
HIND301175F00000X
CAND1141175F00000X
OR1889175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175F00000XOther Service ProvidersNaturopathGroup - Single Specialty