Provider Demographics
NPI:1982782355
Name:FONG, TOWIE (MD)
Entity Type:Individual
Prefix:
First Name:TOWIE
Middle Name:
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 1:818 JACKSON ST SUITE 301
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133
Mailing Address - Country:US
Mailing Address - Phone:445-398-6624
Mailing Address - Fax:415-398-1326
Practice Address - Street 1:818 JACKSON ST SUITE 301
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133
Practice Address - Country:US
Practice Address - Phone:445-398-6624
Practice Address - Fax:415-398-1326
Is Sole Proprietor?:No
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG27352207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G273520Medicaid
CA00G273520Medicaid
F15408Medicare UPIN