Healthcare Provider Details

I. General information

NPI: 1497716930
Provider Name (Legal Business Name): HENRY HANG-YEE FUNG, D.D.S. INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/31/2006
Last Update Date: 05/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5424 E BEVERLY BLVD
LOS ANGELES CA
90022-2208
US

IV. Provider business mailing address

5424 E BEVERLY BLVD
LOS ANGELES CA
90022-2208
US

V. Phone/Fax

Practice location:
  • Phone: 323-721-3312
  • Fax: 323-721-8822
Mailing address:
  • Phone: 323-721-3312
  • Fax: 323-721-8822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code122300000X
TaxonomyDentist
License Number30354
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number30354
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code1223S0112X
TaxonomyOral and Maxillofacial Surgery (Dentist)
License Number30354
License Number StateCA
# 4
Primary TaxonomyN
Taxonomy Code171100000X
TaxonomyAcupuncturist
License NumberAC001426
License Number StateCA

VIII. Authorized Official

Name: MARGARET FUNG
Title or Position: MANAGER
Credential:
Phone: 323-721-3312