Provider Demographics
NPI:1255621876
Name:FONG, ALAN (MD)
Entity type:Individual
Prefix:
First Name:ALAN
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:ALAN
Other - Middle Name:
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:78 REHNBORG DR
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-8432
Mailing Address - Country:US
Mailing Address - Phone:562-533-2060
Mailing Address - Fax:
Practice Address - Street 1:234 S 1ST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-3607
Practice Address - Country:US
Practice Address - Phone:626-447-7008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-15
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME123616207W00000X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program