Provider Demographics
NPI:1356364871
Name:FONG, DENNIS YUNMING (MD)
Entity type:Individual
Prefix:DR
First Name:DENNIS
Middle Name:YUNMING
Last Name:FONG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
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
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG82720207Q00000X
CAG83720207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG83720OtherCALIFORNIA LICENSE NUMBER
CAF91519Medicare UPIN
F91519Medicare UPIN
CA00G837200Medicare ID - Type UnspecifiedMEDICARE PROVIDER ID