Provider Demographics
NPI:1144230996
Name:FONG, TSE-LING (MD)
Entity Type:Individual
Prefix:DR
First Name:TSE-LING
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 31309
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90031-0309
Mailing Address - Country:US
Mailing Address - Phone:323-442-5100
Mailing Address - Fax:
Practice Address - Street 1:1520 SAN PABLO ST
Practice Address - Street 2:SUITE 1000
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90033-5310
Practice Address - Country:US
Practice Address - Phone:323-442-5100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG50388207RG0100X, 207RI0008X, 207RT0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RT0003XAllopathic & Osteopathic PhysiciansInternal MedicineTransplant Hepatology
No207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
No207RI0008XAllopathic & Osteopathic PhysiciansInternal MedicineHepatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1356390009OtherGROUP NPI
CAW11675OtherGROUP MEDICARE PIN
CACE1617OtherGROUP RAILROAD MEDICARE
CA00G503880197OtherCAL OPTIMA
CA100015212OtherRAILROAD MEDICARE
CA00G503880OtherBLUE SHIELD
CAGR0100430OtherGROUP MEDICAL
CA00G503880Medicaid
CAGR0016910OtherGROUP MEDICAID PIN
CA1902846306OtherGROUP NPI
CAW18762OtherGROUP MEDICARE
CAWG50388EMedicare PIN
CA00G503880197OtherCAL OPTIMA