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Licensing details for: PTL 3647

Name: FONG, ANNA MICHELLE

License Type: Postgraduate Training License

Primary Status: License Canceled Primary Status Definition

School Name: California Northstate University College of Medicine

Graduation Year: 2020

Previous Names: Fong, Anna Michelle

Current Enrolled Postgraduate Training Program

Facility Name: University of California (Irvine)/Children's Hospital of Orange County Program

City: Orange

State: California

Speciality: Pediatrics

Start Date: 06/15/2020

Anticipated End Date: 06/30/2023

Address of Record

505 S Main St Ste 525
ORANGE CA 92868-4509
ORANGE county
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Issuance Date

September 23, 2020

Expiration Date

N/A

Current Date / Time

July 7, 2025
7:6:5 AM

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License Relationships

Postgraduate Training License associated with Physician & Surgeon License

License/Registration Role: Postgraduate Training License

Related Party Role: Physician & Surgeon

Name: FONG, ANNA MICHELLE

License/Registration Type: Physician's and Surgeon's

License Number: 178957 Primary Status: License Renewed & Current

Address :
1011 Baldwin Park Blvd
BALDWIN PARK CA 91706-5806
LOS ANGELES COUNTY

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