| NPI | 1508052382 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | CLARK L FONG, DDS Owner 650-366-0552 |
| Organization Subpart ? | No |
| Primary Taxonomy | 1223G0001X Dentist, General Practice (Licence: CA 40351) |
| Enumeration Date | 2007-09-14 |
| Last Update Date | 2010-03-18 |