Provider Demographics
NPI:1407849284
Name:FONG, MINCH K (MD)
Entity Type:Individual
Prefix:
First Name:MINCH
Middle Name:K
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:24953 PASEO DE VALENCIA
Mailing Address - Street 2:#25B
Mailing Address - City:LAGUNA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:92653-4342
Mailing Address - Country:US
Mailing Address - Phone:949-770-8168
Mailing Address - Fax:949-770-2991
Practice Address - Street 1:27800 MEDICAL CENTER RD
Practice Address - Street 2:#304
Practice Address - City:MISSION VIEJO
Practice Address - State:CA
Practice Address - Zip Code:92691-6410
Practice Address - Country:US
Practice Address - Phone:949-770-8168
Practice Address - Fax:949-770-2991
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-26
Last Update Date:2007-07-08
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Provider Licenses
StateLicense IDTaxonomies
CAG70910207RH0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RH0003XAllopathic & Osteopathic PhysiciansInternal MedicineHematology & Oncology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G709100Medicaid
CA00G709100Medicaid