Active NPI
Kristen E Fong, MFT
- Preferred Provider Organization
- San Rafael, CA
National Provider Identifier
1790955516
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Preferred Provider Organization
- License
- MFC36228
- Practice address
- 1050 Northgate Dr
Suite 12
San Rafael, CA 94903-2526 - Phone
- (415) 250-0541
- NPI assigned
- Mar 7, 2008
- Sex
- Female
- Sole proprietor
- Yes
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 |
|---|---|---|---|---|
| Preferred Provider Organization | 305R00000X | MFC36228 | CA | Primary |
Addresses
Primary practice location
1050 Northgate Dr
Suite 12
San Rafael, CA 94903-2526
Mailing address
1050 Northgate Dr
Suite 12
San Rafael, CA 94903-2526
Phone (415) 250-0541
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| MFC36228 | CA | MD | Preferred Provider Organization |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1204848000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1437350400000",
"number": "1790955516",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1050 NORTHGATE DR",
"address_2": "SUITE 12",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949032526",
"telephone_number": "415-250-0541"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1050 NORTHGATE DR",
"address_2": "SUITE 12",
"city": "SAN RAFAEL",
"state": "CA",
"postal_code": "949032526",
"telephone_number": "415-250-0541"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONG",
"first_name": "KRISTEN",
"middle_name": "E",
"credential": "MFT",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2008-03-07",
"last_updated": "2015-07-20",
"status": "A"
},
"taxonomies": [
{
"code": "305R00000X",
"taxonomy_group": "",
"desc": "Preferred Provider Organization",
"state": "CA",
"license": "MFC36228",
"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 Jul 20, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.