Provider Demographics
NPI:1114256955
Name:FONG, JENNIFER K (DPM)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:K
Last Name:FONG
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 OWENS ST FL 2
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94158-2261
Mailing Address - Country:US
Mailing Address - Phone:415-833-2291
Mailing Address - Fax:
Practice Address - Street 1:1600 OWENS ST FL 2
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94158-2261
Practice Address - Country:US
Practice Address - Phone:415-833-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2022-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5901002342213ES0103X
PASC006409213ES0103X
CAE5041213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery