Provider Demographics
NPI:1568668366
Name:FONG, MICHAEL KA HO (MD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:KA HO
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8203 BEVERLY DR
Mailing Address - Street 2:
Mailing Address - City:SAN GABRIEL
Mailing Address - State:CA
Mailing Address - Zip Code:91775-2401
Mailing Address - Country:US
Mailing Address - Phone:626-309-7584
Mailing Address - Fax:
Practice Address - Street 1:4950 W SUNSET BLVD
Practice Address - Street 2:4TH FLOOR
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90027-5822
Practice Address - Country:US
Practice Address - Phone:626-975-1685
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-27
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61085208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery