Bruce Kirin Fong, DO

Primary specialty

Internal Medicine PhysicianTaxonomy code 207R00000X

License

909 Issued in NV

Practice address

9333 Double R Blvd
Suite 100
Reno, NV 89521-3102

Phone

(775) 828-5388

Fax

(775) 828-6588

NPI assigned

Jul 20, 2006

Reactivated

Feb 18, 2015

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

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.

Opted out of Medicare

Previously, effective Jul 31, 2014 through Jul 31, 2026

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

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.

• Sierra Integrated Medicine

  • Internal Medicine Physician
  • Reno, NV
  • NPI 1679610158
  NPD (past) Authorized official

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

{
    "created_epoch": "1153353600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1443744000000",
    "number": "1689694531",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "9333 DOUBLE R BLVD",
            "address_2": "SUITE 100",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895213102",
            "telephone_number": "775-828-5388",
            "fax_number": "775-828-6588"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9333 DOUBLE R BLVD",
            "address_2": "SUITE 100",
            "city": "RENO",
            "state": "NV",
            "postal_code": "895213102",
            "telephone_number": "775-828-5388",
            "fax_number": "775-828-6588"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "BRUCE",
        "middle_name": "KIRIN",
        "name_prefix": "Dr.",
        "credential": "DO",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-07-20",
        "last_updated": "2015-10-02",
        "deactivation_date": "2014-11-25",
        "reactivation_date": "2015-02-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "NV",
            "license": "909",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Donald Kurtis Folgner, DDS
• Gil Folk
• Victoria Follette, PHD
• Amie Folster, PRSS
• Sue Foltz
• Alma Fonseca, RN
• Joanne Fontana, LCSW
• Georgina Noemi Fontein, M.A. LMFT
• Antonio Herlander Fontelonga
• Mervyns Janapin Fontillas

• Internal Medicine Physician in Reno, NV
• Providers in Reno, NV by specialty
• Internal Medicine Physician in Nevada

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 2, 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; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.