Provider Demographics
NPI:1790158715
Name:HOM FONG ENTERPRISES
Entity Type:Organization
Organization Name:HOM FONG ENTERPRISES
Other - Org Name:TOT TANK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JASON
Authorized Official - Middle Name:
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:510-865-8265
Mailing Address - Street 1:1413 PARK ST
Mailing Address - Street 2:
Mailing Address - City:ALAMEDA
Mailing Address - State:CA
Mailing Address - Zip Code:94501-4509
Mailing Address - Country:US
Mailing Address - Phone:510-865-8265
Mailing Address - Fax:510-865-8264
Practice Address - Street 1:1413 PARK ST
Practice Address - Street 2:
Practice Address - City:ALAMEDA
Practice Address - State:CA
Practice Address - Zip Code:94501-4509
Practice Address - Country:US
Practice Address - Phone:510-865-8265
Practice Address - Fax:510-865-8264
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA101109122332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies