Provider Demographics
NPI:1538366489
Name:ENG, BONAVENTURE FOOSONG (MD)
Entity type:Individual
Prefix:
First Name:BONAVENTURE
Middle Name:FOOSONG
Last Name:ENG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:2230 LYNN ROAD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:THOUSAND OAKS
Mailing Address - State:CA
Mailing Address - Zip Code:91360
Mailing Address - Country:US
Mailing Address - Phone:805-497-0961
Mailing Address - Fax:805-496-4818
Practice Address - Street 1:2230 LYNN ROAD
Practice Address - Street 2:SUITE 104
Practice Address - City:THOUSAND OAKS
Practice Address - State:CA
Practice Address - Zip Code:91360
Practice Address - Country:US
Practice Address - Phone:805-497-0961
Practice Address - Fax:805-496-4818
Is Sole Proprietor?:No
Enumeration Date:2007-07-02
Last Update Date:2012-10-31
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG22291207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology