Provider Demographics
NPI:1528603248
Name:FONG, NEIL
Entity Type:Individual
Prefix:
First Name:NEIL
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:800 N 1ST ST
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95112-6312
Mailing Address - Country:US
Mailing Address - Phone:408-299-0462
Mailing Address - Fax:408-299-0469
Practice Address - Street 1:800 N 1ST ST
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95112-6312
Practice Address - Country:US
Practice Address - Phone:408-299-0462
Practice Address - Fax:408-299-0469
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-18
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health