Individual
BRIAN CHI-MING FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
4310 COLBY AVE, SUITE 203, EVERETT, WA 98203-2338
(425) 252-8102
(425) 339-0835
Mailing address
PO BOX 3360, PORTLAND, OR 97208-3360
(866) 747-2455
Taxonomy
Speciality
Code
Description
License number
State
208800000X
Urology Physician
Primary
44010
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
8406977
—
WA
01
—
I13494G
MEDICARE ID-PIN
WA
Enumeration date
07/07/2006
Last updated
05/18/2021
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