Provider Demographics
NPI:1679739569
Name:FONG, DARIN (DDS)
Entity type:Individual
Prefix:
First Name:DARIN
Middle Name:
Last Name:FONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8907 WARNER AVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92647-5075
Mailing Address - Country:US
Mailing Address - Phone:714-848-7777
Mailing Address - Fax:714-848-7388
Practice Address - Street 1:8907 WARNER AVE
Practice Address - Street 2:SUITE 100
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-5075
Practice Address - Country:US
Practice Address - Phone:714-848-7777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-31
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41079122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist