Individual
EDWARD FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
747 52ND ST, SUITE 5409, OAKLAND, CA 94609-1809
(510) 428-3305
(510) 597-7154
Mailing address
747 52ND ST, SUITE 5409, OAKLAND, CA 94609-1809
(510) 428-3305
(510) 597-7154
Taxonomy
Speciality
Code
Description
License number
State
2080P0214X
Pediatric Pulmonology Physician
Primary
A87813
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
00A878130
—
CA
05
—
100508836
—
NV
Enumeration date
08/19/2006
Last updated
07/09/2007
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