| Doctor Name: | DR. NORA LILLIAN FONG |
| NPI Number: | 1609248053 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.D. |
| License Number: | G65297 |
| Business Practice Address: | 425 15th St. Manhattan Beach, CA - 90266 |
| Business Phone Number: | 3108028760 |
| Business Fax Number: | |
| Mailing Address: | Po Box 3266, MANHATTAN BEACH |
| State: | CA |
| Postal Code: | 90266 |
| Phone Number: | 3105467686 |
| Fax Number: | |
| NPI Enumeration Date: | 10/26/2015 |
| NPI Last Update Date: | 10/26/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G65297 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |