Basic Information
| Provider Information | |||||||||
| NPI: | 1205925922 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FONG | ||||||||
| FirstName: | JENIFER | ||||||||
| MiddleName: | C. | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1946 YOUNG ST | ||||||||
| Address2: | SUITE 360 | ||||||||
| City: | HONOLULU | ||||||||
| State: | HI | ||||||||
| PostalCode: | 968262150 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8089737320 | ||||||||
| FaxNumber: | 8089737325 | ||||||||
| Practice Location | |||||||||
| Address1: | 98-151 PALI MOMI ST | ||||||||
| Address2: | SUITE 152 | ||||||||
| City: | AIEA | ||||||||
| State: | HI | ||||||||
| PostalCode: | 967014300 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8084836472 | ||||||||
| FaxNumber: | 8084836473 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/12/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207N00000X | MD-7853 | HI | Y | Allopathic & Osteopathic Physicians | Dermatology |
No ID Information.