Provider Demographics
NPI:1871634311
Name:FONG, MICHAEL
Entity Type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:CHENG
Other - Middle Name:KAE
Other - Last Name:SAEFONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:310 8TH ST STE 201
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-6527
Mailing Address - Country:US
Mailing Address - Phone:510-869-6019
Mailing Address - Fax:
Practice Address - Street 1:310 8TH ST STE 201
Practice Address - Street 2:
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6527
Practice Address - Country:US
Practice Address - Phone:510-869-6019
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator