Individual
MR. FAN DONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Contact information
Practice address
5826 SAMET DR STE 101, HIGH POINT, NC 27265-3661
(336) 878-6540
(336) 716-3202
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
0010-02621
NC
363AM0700X
Medical Physician Assistant
0010-02621
NC
363AS0400X
Surgical Physician Assistant
0010-02621
NC
Other
Enumeration date
12/22/2010
Last updated
08/07/2019
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