Provider Demographics
NPI:1124817481
Name:FONG, DAVID J
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:J
Last Name:FONG
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1903 SAINT NORBERT DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94526-5531
Mailing Address - Country:US
Mailing Address - Phone:925-963-3637
Mailing Address - Fax:
Practice Address - Street 1:1903 SAINT NORBERT DR
Practice Address - Street 2:
Practice Address - City:DANVILLE
Practice Address - State:CA
Practice Address - Zip Code:94526-5531
Practice Address - Country:US
Practice Address - Phone:925-963-3637
Practice Address - Fax:925-963-3637
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-03
Last Update Date:2025-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO12917183500000X
CA29431183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist