Individual
DR. KENTON D FONG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
MD
Contact information
Practice address
845 JACKSON ST, SAN FRANCISCO, CA 94133-4899
(415) 982-2400
Mailing address
1238 12TH AVE APT 4, SAN FRANCISCO, CA 94122-2235
(650) 799-6298
Taxonomy
Speciality
Code
Description
License number
State
208200000X
Plastic Surgery Physician
Primary
A93721
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
A93721
MEDICAL LICENSE
CA
Enumeration date
10/31/2007
Last updated
09/13/2019
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