Provider Demographics
NPI:1790768554
Name:FONG, KATHERINE KWOK-MEI (MD)
Entity Type:Individual
Prefix:DR
First Name:KATHERINE
Middle Name:KWOK-MEI
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 BELLA VIS
Mailing Address - Street 2:
Mailing Address - City:GEORGETOWN
Mailing Address - State:TX
Mailing Address - Zip Code:78633-4496
Mailing Address - Country:US
Mailing Address - Phone:254-742-4995
Mailing Address - Fax:254-742-4681
Practice Address - Street 1:1901 VETERANS MEMORIAL DRIVE
Practice Address - Street 2:CENTRAL TEXAS VETERANS HEALTHCARE - AMBULATORY CARE
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76504
Practice Address - Country:US
Practice Address - Phone:254-742-4995
Practice Address - Fax:254-742-4681
Is Sole Proprietor?:No
Enumeration Date:2005-11-25
Last Update Date:2012-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA78005207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA3112411Medicaid
MAF63687Medicare UPIN
MACX4119Medicare PIN