Provider Demographics
NPI:1538231972
Name:PAU K FONG MD INC
Entity type:Organization
Organization Name:PAU K FONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAU
Authorized Official - Middle Name:KEE
Authorized Official - Last Name:FONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-454-5555
Mailing Address - Street 1:3939 J STREET
Mailing Address - Street 2:SUITE #350
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95819-3671
Mailing Address - Country:US
Mailing Address - Phone:916-454-5555
Mailing Address - Fax:916-454-3754
Practice Address - Street 1:3939 J STREET
Practice Address - Street 2:SUITE #350
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95819-3671
Practice Address - Country:US
Practice Address - Phone:916-454-5555
Practice Address - Fax:916-454-3754
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAU K FONG MD INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-11-14
Last Update Date:2007-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG33418207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G334180Medicaid
CA00G334180Medicaid