Provider Demographics
NPI:1710995717
Name:FONG, DAVID (DPM)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:950 STOCKTON ST
Mailing Address - Street 2:STE 300
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94108-1676
Mailing Address - Country:US
Mailing Address - Phone:510-268-1921
Mailing Address - Fax:510-268-9742
Practice Address - Street 1:950 STOCKTON ST
Practice Address - Street 2:STE 300
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94108-1676
Practice Address - Country:US
Practice Address - Phone:510-268-1921
Practice Address - Fax:510-268-9742
Is Sole Proprietor?:No
Enumeration Date:2006-08-04
Last Update Date:2017-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3379213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000E33790Medicaid
CA000E33791Medicaid
CA000E33790Medicare ID - Type Unspecified
CA000E33791Medicaid
CA000E33791Medicare ID - Type Unspecified