Provider Demographics
NPI:1215047659
Name:FONG, LEO L (MD)
Entity type:Individual
Prefix:
First Name:LEO
Middle Name:L
Last Name:FONG
Suffix:
Gender:
Credentials:MD
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Mailing Address - Street 1:3120 WILLOW AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:CLOVIS
Mailing Address - State:CA
Mailing Address - Zip Code:93612-4714
Mailing Address - Country:US
Mailing Address - Phone:209-613-2927
Mailing Address - Fax:209-538-6010
Practice Address - Street 1:3120 WILLOW AVE STE 101
Practice Address - Street 2:
Practice Address - City:CLOVIS
Practice Address - State:CA
Practice Address - Zip Code:93612-4714
Practice Address - Country:US
Practice Address - Phone:559-721-4910
Practice Address - Fax:559-721-4920
Is Sole Proprietor?:No
Enumeration Date:2006-08-30
Last Update Date:2025-03-17
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG795762086S0129X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00238615OtherRAILROAD MEDICARE
CA00G795760Medicaid
CAG98789Medicare UPIN