Basic Information
| Provider Information | |||||||||
| NPI: | 1841558103 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | FONG | ||||||||
| FirstName: | YI-JEN | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 775 FERN RDG | ||||||||
| Address2: | |||||||||
| City: | FELTON | ||||||||
| State: | CA | ||||||||
| PostalCode: | 950189028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3103398534 | ||||||||
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| Practice Location | |||||||||
| Address1: | 4370 ALPINE RD | ||||||||
| Address2: | SUITE #206 | ||||||||
| City: | PORTOLA VALLEY | ||||||||
| State: | CA | ||||||||
| PostalCode: | 94028 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6503766010 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/24/2012 | ||||||||
| LastUpdateDate: | 09/27/2022 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/21/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207R00000X | A124113 | CA | Y | Allopathic & Osteopathic Physicians | Internal Medicine |
No ID Information.