Provider Demographics
NPI:1588828727
Name:FONG, FREDERICK (MD)
Entity Type:Individual
Prefix:DR
First Name:FREDERICK
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1380 LUSITANA ST
Mailing Address - Street 2:SUITE 514
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96813-2449
Mailing Address - Country:US
Mailing Address - Phone:808-531-7551
Mailing Address - Fax:808-537-3652
Practice Address - Street 1:1380 LUSITANA ST
Practice Address - Street 2:SUITE 514
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96813-2449
Practice Address - Country:US
Practice Address - Phone:808-531-7551
Practice Address - Fax:808-537-3652
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-16
Last Update Date:2008-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HIMD2477207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine