Kelly Fong, DDS

Primary specialty

Student in an Organized Health Care Education/Training ProgramTaxonomy code 390200000X

Practice address

240 S 40TH St
Philadelphia, PA 19104-6030

Phone

(215) 898-6555

NPI assigned

May 5, 2025

Sex

Unspecified or another gender identity

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Locations

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.

• Justin Tin DDS Dental Group a Professional Corporation

  dba stannum dental group

  • Dentist
  • San Francisco, CA
  • NPI 1649900622
  NPD

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

{
    "created_epoch": "1746403200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784160000000",
    "number": "1295524213",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "244 MONCADA WAY",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941272706",
            "telephone_number": "415-361-2632"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "240 S 40TH ST",
            "city": "PHILADELPHIA",
            "state": "PA",
            "postal_code": "191046030",
            "telephone_number": "215-898-6555"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "KELLY",
        "credential": "DDS",
        "sole_proprietor": "NO",
        "sex": "X",
        "enumeration_date": "2025-05-05",
        "last_updated": "2026-07-16",
        "certification_date": "2026-07-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS110547",
            "primary": false
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": "PA",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jessica Foltz
• Rhonda Sue Foltz, CRNP
• Julianna Fomenko, LCSW
• Lauren Amanda Fonde, DO
• Amy Wan Fong, MD
• Yombe Fonkeu, MD
• Roger A Fons, MD
• Allison Ryan Font, MD
• Zuleika C Font, M.D.
• Jean H Fontaine, D.C.

• Student in an Organized Health Care Education/Training Program in Philadelphia, PA
• Providers in Philadelphia, PA by specialty
• Student in an Organized Health Care Education/Training Program in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 16, 2026; 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.