Provider Demographics
NPI:1871149922
Name:FONG, CHIN LUNG (LCSW)
Entity type:Individual
Prefix:
First Name:CHIN
Middle Name:LUNG
Last Name:FONG
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:CHIN
Other - Middle Name:LUNG
Other - Last Name:FONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:KYLE FONG
Mailing Address - Street 1:4850 TASSAJARA RD APT 2312
Mailing Address - Street 2:
Mailing Address - City:DUBLIN
Mailing Address - State:CA
Mailing Address - Zip Code:94568-4602
Mailing Address - Country:US
Mailing Address - Phone:415-706-7508
Mailing Address - Fax:925-685-1528
Practice Address - Street 1:4800 TASSAJARA RD
Practice Address - Street 2:
Practice Address - City:DUBLIN
Practice Address - State:CA
Practice Address - Zip Code:94568-4509
Practice Address - Country:US
Practice Address - Phone:415-706-7508
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-14
Last Update Date:2024-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA1070491041C0700X
CAASW90172104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker