Provider Demographics
NPI:1467464867
Name:FONG, BENJAMIN ZEE (MD)
Entity Type:Individual
Prefix:DR
First Name:BENJAMIN
Middle Name:ZEE
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:1 SHRADER ST
Mailing Address - Street 2:#500
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94117-1016
Mailing Address - Country:US
Mailing Address - Phone:415-831-6441
Mailing Address - Fax:415-831-6443
Practice Address - Street 1:1 SHRADER ST
Practice Address - Street 2:#500
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94117-1016
Practice Address - Country:US
Practice Address - Phone:415-831-6441
Practice Address - Fax:415-831-6443
Is Sole Proprietor?:No
Enumeration Date:2006-08-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG49382207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G493820Medicaid
CAA51351Medicare UPIN
CA00G493820Medicaid