Frederick Fong Md Inc | |
1380 Lustiana Street Suite 514 Honolulu HI 96813-2441 | |
(808) 531-7551 | |
(808) 537-3652 |
Full Name | Frederick Fong Md Inc |
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Speciality | Internal Medicine |
Location | 1380 Lustiana Street, Honolulu, Hawaii |
Authorized Official Name and Position | Frederick Fong (PRESIDENT) |
Authorized Official Contact | 8085317551 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
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Frederick Fong Md Inc 1380 Lustiana Street Suite 514 Honolulu HI 96813-2441 Ph: (808) 531-7551 | Frederick Fong Md Inc 1380 Lustiana Street Suite 514 Honolulu HI 96813-2441 Ph: (808) 531-7551 |
NPI Number | 1013066992 |
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Provider Enumeration Date | 01/09/2007 |
Last Update Date | 08/22/2020 |
Medicare PECOS PAC ID | 3072754241 |
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Medicare Enrollment ID | O20130731000107 |
Identifier | Type | State | Issuer |
---|---|---|---|
1013066992 | NPI | - | NPPES |
38893 | Other | HI | BLUE CROSS |
52862201 | Medicaid | HI |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
207R00000X | Internal Medicine | MD2477 (Hawaii) | Primary |
Provider Name | Frederick Fong |
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Provider Type | Practitioner - Internal Medicine |
Provider Identifiers | NPI Number: 1588828727 PECOS PAC ID: 4981625464 Enrollment ID: I20051212000828 |
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