Provider Demographics
NPI:1952559585
Name:FONG, GRACE (DO)
Entity type:Individual
Prefix:
First Name:GRACE
Middle Name:
Last Name:FONG
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1100 LARKSPUR LANDING CIR STE 10
Mailing Address - Street 2:
Mailing Address - City:LARKSPUR
Mailing Address - State:CA
Mailing Address - Zip Code:94939-1836
Mailing Address - Country:US
Mailing Address - Phone:415-924-1214
Mailing Address - Fax:415-924-1375
Practice Address - Street 1:1100 LARKSPUR LANDING CIR STE 10
Practice Address - Street 2:
Practice Address - City:LARKSPUR
Practice Address - State:CA
Practice Address - Zip Code:94939-1836
Practice Address - Country:US
Practice Address - Phone:415-924-1214
Practice Address - Fax:415-924-1375
Is Sole Proprietor?:No
Enumeration Date:2008-09-08
Last Update Date:2025-07-07
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Provider Licenses
StateLicense IDTaxonomies
CA20A9698207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA20A9698OtherSTATE MEDICAL LICENSE