Individual
CALVIN CHANG FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
M.D.
Contact information
Practice address
2336 SANTA MONICA BLVD STE 301, SANTA MONICA, CA 90404-2067
(310) 998-9118
(310) 829-9318
Mailing address
5767 W CENTURY BLVD STE 400, LOS ANGELES, CA 90045-5631
(310) 301-8771
(310) 301-8751
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
A160624
CA
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
04/06/2017
Last updated
10/07/2020
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