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Individual

DANIEL FONG JR.

Active
Sole proprietor
No

Provider details

NPI number
Gender
Man
Credential
PA-C

Contact information

Practice address
10 W BROADWAY FL 7, SALT LAKE CITY, UT 84101-2060
(866) 849-0692
Mailing address
777 AVENUE H, POWELL, WY 82435-2260
(307) 754-2267

Taxonomy

Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
14268608-1206
UT
363A00000X
Physician Assistant
PA.0004438
CO
363A00000X
Physician Assistant
Primary
WY
363AS0400X
Surgical Physician Assistant
PA.0004438
CO

Other

Enumeration date
10/30/2015
Last updated
02/04/2026
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