Individual
CHUN CHUNG FONG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
IDMT
Contact information
Practice address
3278 MITCHELL BLVD BLDG 900, MOODY AFB, GA 31699-1500
(813) 503-0354
Mailing address
3278 MITCHELL BLVD BLDG 900, MOODY AFB, GA 31699-1500
Taxonomy
Speciality
Code
Description
License number
State
1710I1003X
Independent Duty Medical Technicians
Primary
—
—
Other
Enumeration date
06/23/2010
Last updated
11/21/2014
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