Provider Demographics
NPI:1346228707
Name:FONG, MEI-LING ELIZABETH (MD)
Entity Type:Individual
Prefix:DR
First Name:MEI-LING
Middle Name:ELIZABETH
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:1000 S ELISEO DR
Mailing Address - Street 2:STE 200
Mailing Address - City:GREENBRAE
Mailing Address - State:CA
Mailing Address - Zip Code:94904-2107
Mailing Address - Country:US
Mailing Address - Phone:415-752-7141
Mailing Address - Fax:415-689-7626
Practice Address - Street 1:1000 S ELISEO DR
Practice Address - Street 2:STE 200
Practice Address - City:GREENBRAE
Practice Address - State:CA
Practice Address - Zip Code:94904-2107
Practice Address - Country:US
Practice Address - Phone:415-752-7141
Practice Address - Fax:415-689-7626
Is Sole Proprietor?:No
Enumeration Date:2006-01-05
Last Update Date:2019-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA63227207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA3054233Medicaid
CA00A632270Medicare ID - Type Unspecified
CAG62315Medicare UPIN