Individual provider Active NPI

Calvin Chang Fong, M.D.

  • Family Medicine Physician
  • Santa Monica, CA
National Provider Identifier
1609309764
Registry record updated Oct 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Medicine PhysicianTaxonomy code 207Q00000X
License
A160624 Issued in CA
Practice address
2336 Santa Monica Blvd Ste 301
Santa Monica, CA 90404-2067
Phone
(310) 998-9118
Fax
(310) 829-9318
NPI assigned
Apr 6, 2017
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Oct 7, 2020

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Student in an Organized Health Care Education/Training Program 390200000X
Family Medicine Physician 207Q00000X A160624 CA Primary

Addresses

Primary practice location

2336 Santa Monica Blvd Ste 301
Santa Monica, CA 90404-2067

Mailing address

5767 W Century Blvd Ste 400
Los Angeles, CA 90045-5631
Phone (310) 301-8771

Other practice location 1

757 Westwood Plz
Family Medicine
Los Angeles, CA 90095-7419
Phone (818) 730-2015

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in CA
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: Yes
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20200512003514 CA Practitioner - Family Practice 3375873409 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Family Practice
Education
Boston University School of Medicine, 2017
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Group practices

Practice addresses (Care Compare)

1250 La Venta Dr
Suite 101a
Westlake Village, CA 91361-3760
Phone (805) 494-6920

2020 Santa Monica Blvd
Suite 210
Santa Monica, CA 90404-2139
Phone (310) 458-2381

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Medicine

State licenses

LicenseStateTypeSpecialty
A160624CAMDFamily Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
The Regents of the University of California CurrentSince Jul 1, 2020 Accepting new patients
The Regents of the University of California Family Medicine CurrentSince Jul 1, 2020 Accepting new patients
UCLA Medical Group Family Medicine Past Accepting new patients
Regents Univ of Calif Los Angeles Past Accepting new patients

Locations

24302 Paseo de Valencia
Ste 200
Laguna Hills, CA 92653
Phone (949) 458-8252

757 Westwood Plz
Los Angeles, CA 90095
Phone (310) 267-9448

5767 W Century Blvd
Ste 400
Los Angeles, CA 90045
Phone (310) 301-5200

File 55737
Los Angeles, CA 90074

2020 Santa Monica Blvd
Ste 210
Santa Monica, CA 90404
Phone (310) 458-2381

2336 Santa Monica Blvd
Ste 301
Santa Monica, CA 90404
Phone (310) 998-9118

100 Moody Ct
Ste 200
Thousand Oaks, CA 91360
Phone (805) 418-3500

1250 La Venta Dr
Ste 101A
Westlake Village, CA 91361
Phone (805) 494-6920

Interoperability endpoints

  • Direct secure messaging: cfong527134@direct.uclahealth.org

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

NPI Registry JSON

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

{
    "created_epoch": "1491436800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1602028800000",
    "number": "1609309764",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5767 W CENTURY BLVD STE 400",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900455631",
            "telephone_number": "310-301-8771",
            "fax_number": "310-301-8751"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2336 SANTA MONICA BLVD STE 301",
            "city": "SANTA MONICA",
            "state": "CA",
            "postal_code": "904042067",
            "telephone_number": "310-998-9118",
            "fax_number": "310-829-9318"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "757 Westwood Plz",
            "address_2": "Family Medicine",
            "address_purpose": "LOCATION",
            "city": "Los Angeles",
            "state": "CA",
            "postal_code": "900957419",
            "country_code": "US",
            "telephone_number": "818-730-2015",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "CALVIN",
        "middle_name": "CHANG",
        "credential": "M.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2017-04-06",
        "last_updated": "2020-10-07",
        "certification_date": "2020-10-07",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "CA",
            "license": "A160624",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Santa Monica, CA

Sources for this page

Verify at the official NPI Registry.