Provider Demographics
NPI:1154414118
Name:NICOLAI Y FOONG MD INC
Entity type:Organization
Organization Name:NICOLAI Y FOONG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:NICOLAI
Authorized Official - Middle Name:Y
Authorized Official - Last Name:FOONG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:626-288-3015
Mailing Address - Street 1:723 S GARFIELD AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:ALHAMBRA
Mailing Address - State:CA
Mailing Address - Zip Code:91801-4430
Mailing Address - Country:US
Mailing Address - Phone:626-288-3015
Mailing Address - Fax:626-288-7018
Practice Address - Street 1:723 S GARFIELD AVE STE 301
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-4430
Practice Address - Country:US
Practice Address - Phone:626-288-3015
Practice Address - Fax:626-288-7018
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG58690207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & GynecologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAOOG586900Medicaid
CAOOG586900Medicaid
E42377Medicare UPIN