Provider Demographics
NPI:1245336809
Name:DENNIS Y. FONG, M.D., PROFESSIONAL CORPORATION
Entity type:Organization
Organization Name:DENNIS Y. FONG, M.D., PROFESSIONAL CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:DENNIS
Authorized Official - Middle Name:YUNMING
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-934-2333
Mailing Address - Street 1:108 LA CASA VIA
Mailing Address - Street 2:SUITE 104
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598
Mailing Address - Country:US
Mailing Address - Phone:925-934-2333
Mailing Address - Fax:925-934-2688
Practice Address - Street 1:108 LA CASA VIA
Practice Address - Street 2:SUITE 104
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598
Practice Address - Country:US
Practice Address - Phone:925-934-2333
Practice Address - Fax:925-934-2688
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-14
Last Update Date:2020-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG83720207Q00000X
207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAF91519Medicare UPIN
CAZZZ24126ZMedicare ID - Type UnspecifiedMEDICARE PROVIDER NO.