NPIMap

Individual provider Active NPI

Justin Phillip Fong, M.D.

  • Internal Medicine Physician
  • San Francisco, CA
National Provider Identifier
1841346608
Registry record updated Sep 1, 2009
On this page

Key facts

NPPES NPI Registry
Primary specialty
Internal Medicine PhysicianTaxonomy code 207R00000X
License
G57883 Issued in CA
Practice address
3060 19TH Ave
San Francisco, CA 94132-1627
Phone
(415) 452-3155
Fax
(415) 452-9682
NPI assigned
Jan 26, 2007
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Sep 1, 2009

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Internal Medicine Physician 207R00000X G57883 CA Primary

Addresses

Primary practice location

3060 19TH Ave
San Francisco, CA 94132-1627

Mailing address

3060 19TH Ave
San Francisco, CA 94132-1627
Phone (415) 452-3155

Medicare participation

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

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20050707000481 CA Practitioner - Internal Medicine 6305882770 Practice locations: San Francisco, CA

Care Compare profile

Medicare Care Compare
Specialty
Internal Medicine
Education
University of Southern California Keck School of Medicine, 1984
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services

Practice addresses (Care Compare)

3060 19TH Ave
San Francisco, CA 94132-1627
Phone (415) 452-3155

Hospital & facility affiliations

Procedures performed for Medicare patients

ProcedureNumber of procedures
Removal of tissue1-10

National Provider Directory

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

State licenses

LicenseStateTypeSpecialty
57883CAMDDentist
G57883CAMDInternal Medicine Physician

Practice roles

OrganizationSpecialtyStatusNew patients
California Pacific Medical Group, Inc. Past Accepting new patients
Seton Medical Center Past Accepting new patients
UCSF Health Community Hospitals Past Accepting new patients

Organizations & group practices 3

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.

Hospital & facility affiliations 7

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1169769600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1251763200000",
    "number": "1841346608",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3060 19TH AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941321627",
            "telephone_number": "415-452-3155",
            "fax_number": "415-452-9682"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3060 19TH AVE",
            "city": "SAN FRANCISCO",
            "state": "CA",
            "postal_code": "941321627",
            "telephone_number": "415-452-3155",
            "fax_number": "415-452-9682"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FONG",
        "first_name": "JUSTIN",
        "middle_name": "PHILLIP",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-01-26",
        "last_updated": "2009-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207R00000X",
            "taxonomy_group": "",
            "desc": "Internal Medicine",
            "state": "CA",
            "license": "G57883",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in San Francisco, CA

Sources for this page

Verify at the official NPI Registry.