Provider Demographics
NPI:1528231347
Name:JUON-KIN K. FONG, M.D., INC
Entity Type:Organization
Organization Name:JUON-KIN K. FONG, M.D., INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JUON-KIN
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:510-834-1742
Mailing Address - Street 1:2844 SUMMIT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3637
Mailing Address - Country:US
Mailing Address - Phone:510-834-1742
Mailing Address - Fax:510-834-5315
Practice Address - Street 1:2844 SUMMIT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3637
Practice Address - Country:US
Practice Address - Phone:510-834-1742
Practice Address - Fax:510-834-5315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-12
Last Update Date:2008-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG028841261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF09640Medicare UPIN
CA00G28841Medicare PIN