Provider Demographics
NPI:1114164449
Name:FONG, ALEX (MD)
Entity Type:Individual
Prefix:
First Name:ALEX
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:770 THE CITY DR S
Mailing Address - Street 2:SUITE 4000
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4900
Mailing Address - Country:US
Mailing Address - Phone:800-463-6628
Mailing Address - Fax:714-620-3008
Practice Address - Street 1:361 HOSPITAL RD
Practice Address - Street 2:STE 229
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3522
Practice Address - Country:US
Practice Address - Phone:949-515-7861
Practice Address - Fax:949-515-7846
Is Sole Proprietor?:No
Enumeration Date:2009-01-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAN/A207V00000X
CAA107315207VM0101X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207VM0101XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyMaternal & Fetal Medicine
No207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology