Provider Demographics
NPI:1205925922
Name:FONG, JENIFER C (MD)
Entity type:Individual
Prefix:DR
First Name:JENIFER
Middle Name:C
Last Name:FONG
Suffix:
Gender:F
Credentials:MD
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Mailing Address - Street 1:1946 YOUNG ST
Mailing Address - Street 2:SUITE 360
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96826-2150
Mailing Address - Country:US
Mailing Address - Phone:808-973-7320
Mailing Address - Fax:808-973-7325
Practice Address - Street 1:98-151 PALI MOMI ST
Practice Address - Street 2:SUITE 152
Practice Address - City:AIEA
Practice Address - State:HI
Practice Address - Zip Code:96701-4300
Practice Address - Country:US
Practice Address - Phone:808-483-6472
Practice Address - Fax:808-483-6473
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
HIMD-7853207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIF34474Medicare UPIN