Provider Demographics
NPI:1104186311
Name:FONG, AMELIA ANN (MD)
Entity Type:Individual
Prefix:
First Name:AMELIA
Middle Name:ANN
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Mailing Address - Street 1:MSC 61380 PO BOX 1300
Mailing Address - Street 2:
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96807-1300
Mailing Address - Country:US
Mailing Address - Phone:808-373-4522
Mailing Address - Fax:
Practice Address - Street 1:850 WEST HIND DRIVE
Practice Address - Street 2:212
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96821-1845
Practice Address - Country:US
Practice Address - Phone:808-373-4522
Practice Address - Fax:808-373-3299
Is Sole Proprietor?:No
Enumeration Date:2012-05-22
Last Update Date:2018-04-04
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-19193207WX0109X, 207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No207WX0109XAllopathic & Osteopathic PhysiciansOphthalmologyNeuro-ophthalmology