Brian William Fong, D.M.D.

Primary specialty

DentistTaxonomy code 122300000X

License

50138 Issued in CA

Practice address

3023 Broadway
Redwood City, CA 94062-1511

Phone

(650) 474-0551

Fax

(650) 474-0553

NPI assigned

Sep 15, 2006

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

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1158278400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1720184294",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3023 BROADWAY",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621511",
            "telephone_number": "650-474-0551",
            "fax_number": "650-474-0553"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3023 BROADWAY",
            "city": "REDWOOD CITY",
            "state": "CA",
            "postal_code": "940621511",
            "telephone_number": "650-474-0551",
            "fax_number": "650-474-0553"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "BRIAN",
        "middle_name": "WILLIAM",
        "name_prefix": "Dr.",
        "credential": "D.M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-09-15",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "122300000X",
            "taxonomy_group": "",
            "desc": "Dentist",
            "state": "CA",
            "license": "50138",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Joshua Flores
• Ryan Flores
• Thelma Elena Flores, C037880716
• Linda Beck Flynn
• Marilyn Jane Foley, PH.D.
• Kimberly Ann Fong, RDHAP
• Michelle Josephine Fong
• Michelle M Fong
• Ronald Leigh Fong, MD
• Emmanuel Yves Fonlupt

• Dentist in Redwood City, CA
• Providers in Redwood City, CA by specialty
• Dentist in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; 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.

Verify at the official NPI Registry.