Active NPI
John Fong, MD
- Psychiatry Physician
- Stockton, CA
National Provider Identifier
1841261054
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Psychiatry Physician
- License
- G49494
- Practice address
- 1130 Monaco CT
Stockton, CA 95207 - Phone
- (209) 478-2060
- Fax
- (209) 478-3175
- NPI assigned
- Jan 27, 2006
- Last updated
- Jan 6, 2010
- Sex
- Male
- 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 |
|---|---|---|---|---|
| Psychiatry Physician | 2084P0800X | G49494 | CA | Primary |
Addresses
Primary practice location
1130 Monaco CT
Stockton, CA 95207
Mailing address
PO Box 986
Woodbridge, CA 95258-0986
Phone (209) 339-9036
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00G494940 | Medicaid | CA |
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
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20070329000439 | CA | Practitioner - Psychiatry | 3173627270 | Practice locations: Stockton, CA |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| G49494 | CA | MD | Psychiatry Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1138320000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1262736000000",
"number": "1841261054",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "PO BOX 986",
"city": "WOODBRIDGE",
"state": "CA",
"postal_code": "952580986",
"telephone_number": "209-339-9036",
"fax_number": "209-339-1901"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1130 MONACO CT",
"city": "STOCKTON",
"state": "CA",
"postal_code": "95207",
"telephone_number": "209-478-2060",
"fax_number": "209-478-3175"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FONG",
"first_name": "JOHN",
"name_prefix": "Mr.",
"credential": "MD",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2006-01-27",
"last_updated": "2010-01-06",
"status": "A"
},
"taxonomies": [
{
"code": "2084P0800X",
"taxonomy_group": "",
"desc": "Psychiatry & Neurology, Psychiatry",
"state": "CA",
"license": "G49494",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "00G494940",
"state": "CA"
}
],
"endpoints": [],
"other_names": []
}Other providers in Stockton, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 6, 2010; 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.