Chin Lung Fong, LCSW

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

107049 Issued in CA

Practice address

4800 Tassajara Rd
Dublin, CA 94568-4509

Phone

(415) 706-7508

NPI assigned

Aug 14, 2019

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Chin Lung Fong Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Opted out of Medicare

Yes, effective Dec 29, 2023 through Dec 29, 2027

Medicare enrollment (NPD)

Not enrolled

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.

• A Step Forward

  • Community/Behavioral Health Agency
  • Concord, CA
  • NPI 1922203165
  NPD (past)

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

{
    "created_epoch": "1565740800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1719273600000",
    "number": "1871149922",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4850 TASSAJARA RD APT 2312",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945684602",
            "telephone_number": "415-706-7508",
            "fax_number": "925-685-1528"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4800 TASSAJARA RD",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945684509",
            "telephone_number": "415-706-7508"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "2827 Concord Blvd",
            "address_purpose": "LOCATION",
            "city": "Concord",
            "state": "CA",
            "postal_code": "945192608",
            "country_code": "US",
            "telephone_number": "925-685-9670",
            "fax_number": "925-685-1528",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "FONG",
        "first_name": "CHIN",
        "middle_name": "LUNG",
        "credential": "LCSW",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2019-08-14",
        "last_updated": "2024-06-25",
        "certification_date": "2024-06-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "CA",
            "license": "107049",
            "primary": true
        },
        {
            "code": "104100000X",
            "taxonomy_group": "",
            "desc": "Social Worker",
            "state": "CA",
            "license": "ASW90172",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "CHIN",
            "last_name": "FONG",
            "middle_name": "LUNG",
            "credential": "KYLE FONG",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Viviana Julissa Flores, MSW
• Shuana Fobar
• Susan M Fochler, P.A.
• Zoey Fogerty
• Michael Foglesong
• Karen Fong
• Lai Sun Fong
• Debbie Fonseca
• Brandon Forbes
• Carlos Forcadilla

• Clinical Social Worker in Dublin, CA
• Providers in Dublin, CA by specialty
• Clinical Social Worker in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 25, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Opt Out Affidavits.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.