Active NPI
Peter Fong
- General Practice Dentistry
- San Rafael, CA
National Provider Identifier
1598169534
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 40817
- Practice address
- 2 Civic Center Dr., #4429
San Rafael, CA 94913-4429 - Phone
- (415) 320-0569
- NPI assigned
- Oct 20, 2014
- Last updated
- Jun 5, 2015
- 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 |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 40817 | CA | Primary |
Addresses
Primary practice location
2 Civic Center Dr., #4429
San Rafael, CA 94913-4429
Mailing address
2 Civic Center Dr., #4429
San Rafael, CA 94913-4429
Phone (415) 320-0569
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
- Eligible to order & refer
- Part B services: No
- Medical equipment: Yes
- Home health: No
- Power mobility devices: No
- Hospice: No
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1413763200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1433462400000",
"number": "1598169534",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2 CIVIC CENTER DR., #4429",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949134429",
"telephone_number": "415-320-0569"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2 CIVIC CENTER DR., #4429",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949134429",
"telephone_number": "415-320-0569"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONG",
"first_name": "PETER",
"name_prefix": "Dr.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-20",
"last_updated": "2015-06-05",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "40817",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in San Rafael, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.