Provider Demographics
NPI:1982068342
Name:FOONG, NICOLAI (MD)
Entity Type:Individual
Prefix:
First Name:NICOLAI
Middle Name:
Last Name:FOONG
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 1:723 S GARFIELD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4430
Mailing Address - Country:US
Mailing Address - Phone:626-288-3015
Mailing Address - Fax:626-288-7018
Practice Address - Street 1:723 S GARFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4430
Practice Address - Country:US
Practice Address - Phone:626-288-3015
Practice Address - Fax:626-288-7018
Is Sole Proprietor?:Yes
Enumeration Date:2016-04-11
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG58690Medicare PIN
CAE42377Medicare UPIN