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Licensing details for: A 178957

Name: FONG, ANNA MICHELLE

License Type: Physician and Surgeon A

Primary Status: License Renewed & Current Primary Status Definition

School Name: California Northstate University College of Medicine

Graduation Year: 2020

Previous Names: Fong, Anna Michelle

Address of Record

1011 Baldwin Park Blvd
BALDWIN PARK CA 91706-5806
LOS ANGELES county
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Issuance Date

May 24, 2022

Expiration Date

July 31, 2026

Current Date / Time

July 6, 2025
10:12:23 PM

Public Record Actions

Public Documents

License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Physician & Surgeon

Related Party Role: Postgraduate Training License

Name: FONG, ANNA MICHELLE

License/Registration Type: Postgraduate Training License

License Number: 3647 Primary Status: License Canceled

Address :
505 S Main St Ste 525
ORANGE CA 92868-4509
ORANGE COUNTY

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Survey Information

The following information is self-reported by the licensee and has not been verified by the Board.

Current Training Status
Decline to State
Postgraduate Training Years
Decline to State
Primary Area of Practice
Decline to State
Secondary Area of Practice
Decline to State
ABMS Certifications
Other - Decline to State
Are you retired?
Decline to state
Practice Activities
Direct Patient Care (including telehealth) - Decline to State

Training - Decline to State
Research - Decline to State
Administration - Decline to State
Other - Decline to State
Primary Practice Location
Decline to State
Secondary Practice Location
Decline to State
Are you Hispanic, Latino/a, or of Spanish origin?
Decline to State
Race
Decline to State
Language Fluency
Decline to State
Gender Identity
Decline to State

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