Provider Demographics
NPI:1558569939
Name:FANG, TONY DONGYU (MD)
Entity Type:Individual
Prefix:DR
First Name:TONY
Middle Name:DONGYU
Last Name:FANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:DONGYU
Other - Middle Name:TONY
Other - Last Name:FANG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MD
Mailing Address - Street 1:11948 BOS ST
Mailing Address - Street 2:
Mailing Address - City:CERRITOS
Mailing Address - State:CA
Mailing Address - Zip Code:90703-6905
Mailing Address - Country:US
Mailing Address - Phone:650-799-7122
Mailing Address - Fax:
Practice Address - Street 1:1000 W. CARSON STREET
Practice Address - Street 2:
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90502
Practice Address - Country:US
Practice Address - Phone:310-222-2704
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-06
Last Update Date:2021-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86468174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist