Active NPI
Douglas J. Fong, M.S., L.M.F.T.
- Marriage & Family Therapist
- San Mateo, CA
National Provider Identifier
1114051570
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Marriage & Family Therapist
- License
- MFC33984
- Practice address
- 1950 Alameda de Las Pulgas
San Mateo, CA 94403-1222 - Phone
- (650) 556-6422
- Fax
- (650) 349-0476
- NPI assigned
- Mar 15, 2007
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Marriage & Family Therapist | 106H00000X | MFC33984 | CA | Primary |
Addresses
Primary practice location
1950 Alameda de Las Pulgas
San Mateo, CA 94403-1222
Mailing address
1950 Alameda de Las Pulgas
San Mateo, CA 94403-1222
Phone (650) 556-6422
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Master of Science
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC33984 | CA | MD | Marriage & Family Therapist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| County of San Mateo | Past | Accepting new patients | |
| San Mateo County Health Department | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Community/Behavioral Health Agency
- Redwood City, CA
- NPI 1528432481
-
- Health Maintenance Organization
- San Mateo, CA
- NPI 1891989976
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1173916800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1615161600000",
"number": "1114051570",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1950 ALAMEDA DE LAS PULGAS",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944031222",
"telephone_number": "650-556-6422",
"fax_number": "650-349-0476"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1950 ALAMEDA DE LAS PULGAS",
"city": "SAN MATEO",
"state": "CA",
"postal_code": "944031222",
"telephone_number": "650-556-6422",
"fax_number": "650-349-0476"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONG",
"first_name": "DOUGLAS",
"middle_name": "J.",
"credential": "M.S., L.M.F.T.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-03-15",
"last_updated": "2021-03-08",
"certification_date": "2021-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "106H00000X",
"taxonomy_group": "",
"desc": "Marriage & Family Therapist",
"state": "CA",
"license": "MFC33984",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Mateo, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.