| 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 |
|---|---|
| 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 |
|---|---|
| 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 |
|---|---|
| Provider Enumeration Date | 01/09/2007 |
| Last Update Date | 08/22/2020 |
| Medicare PECOS PAC ID | 3072754241 |
|---|---|
| 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 |
|---|---|
| Provider Type | Practitioner - Internal Medicine |
| Provider Identifiers | NPI Number: 1588828727 PECOS PAC ID: 4981625464 Enrollment ID: I20051212000828 |
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