Provider Demographics
NPI:1609927102
Name:FONG, JUON-KIN K (MD)
Entity Type:Individual
Prefix:
First Name:JUON-KIN
Middle Name:K
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:KENNETH
Other - Middle Name:
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:2844 SUMMIT ST
Mailing Address - Street 2:SUITE 103
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-3637
Mailing Address - Country:US
Mailing Address - Phone:510-834-1742
Mailing Address - Fax:510-834-5315
Practice Address - Street 1:2844 SUMMIT ST
Practice Address - Street 2:SUITE 103
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-3637
Practice Address - Country:US
Practice Address - Phone:510-834-1742
Practice Address - Fax:510-834-5315
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-13
Last Update Date:2008-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG0-28848207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
94-2806866OtherFEDERAL TAX ID
CAF09640Medicare UPIN
94-2806866OtherFEDERAL TAX ID