Healthcare Provider Details

I. General information

NPI: 1033572110
Provider Name (Legal Business Name): DEBORAH FUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: DEBORAH MOON GA YOUNG MOON

II. Dates (important events)

Enumeration Date: 04/05/2016
Last Update Date: 12/23/2025
Certification Date: 12/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14305 MERIDIAN PKWY
RIVERSIDE CA
92518-3034
US

IV. Provider business mailing address

14305 MERIDIAN PKWY
RIVERSIDE CA
92518-3034
US

V. Phone/Fax

Practice location:
  • Phone: 866-984-7483
  • Fax: 951-529-6371
Mailing address:
  • Phone: 866-984-7483
  • Fax: 951-251-7464

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberA181968
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: