Individual
SUSIE X FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.D.
Contact information
Practice address
15503 VENTURA BLVD STE 170, ENCINO, CA 91436
(818) 461-8148
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
Taxonomy
Speciality
Code
Description
License number
State
207R00000X
Internal Medicine Physician
A129474
CA
207RS0012X
Sleep Medicine (Internal Medicine) Physician
Primary
A129474
CA
Other
Enumeration date
03/29/2011
Last updated
03/04/2020
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