Provider Demographics
NPI:1609057041
Name:FONG, DEAN (DO)
Entity Type:Individual
Prefix:DR
First Name:DEAN
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:350 ST. JOSEPH'S STREET
Mailing Address - Street 2:KAISER PERMANENTE MEDICAL CENTER
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94115
Mailing Address - Country:US
Mailing Address - Phone:415-833-4188
Mailing Address - Fax:
Practice Address - Street 1:350 ST. JOSEPH'S STREET
Practice Address - Street 2:KAISER PERMANENTE MEDICAL CENTER
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-833-4188
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-11-14
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA20A9526207ZP0102X
ME1912207ZP0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207ZP0102XAllopathic & Osteopathic PhysiciansPathologyAnatomic Pathology & Clinical Pathology