Grant Russell Fong, DDS

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS105756 Issued in CA

Practice address

3000 L St Ste 215
Sacramento, CA 95816-5248

Phone

(916) 457-7080

NPI assigned

Nov 30, 2020

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1606694400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1606694400000",
    "number": "1174127138",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "820 COBBLE COVE LN",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958314309",
            "telephone_number": "916-217-3177"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3000 L ST STE 215",
            "city": "SACRAMENTO",
            "state": "CA",
            "postal_code": "958165248",
            "telephone_number": "916-457-7080"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "GRANT",
        "middle_name": "RUSSELL",
        "name_prefix": "Dr.",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2020-11-30",
        "last_updated": "2020-11-30",
        "certification_date": "2020-11-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS105756",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "OTHERS",
            "endpointTypeDescription": "Other URL",
            "endpoint": "grantfong5@gmail.com",
            "affiliation": "N",
            "endpointDescription": "Email",
            "address_1": "3000 L St Ste 215",
            "city": "Sacramento",
            "state": "CA",
            "country_code": "US",
            "postal_code": "958165248",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Don P Fong, O.D.
• Edward Bak Fong, D.D.S.
• Elvira Fong, LMFT
• Eugene Fong
• Georgina Ngit Ngo Fong, P. T.
• Jennifer Lee Fong, D.C., L.AC
• Jennifer Lynn Fong, O.D.
• Kimberly Ann Fong, D.D.S.
• Latisha Antoinette Fong
• Leslie Thomas Fong, D.D.S.

• General Practice Dentistry in Sacramento, CA
• Providers in Sacramento, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 30, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.