Healthcare Provider Details

I. General information

NPI: 1417480252
Provider Name (Legal Business Name): EMILY KATHRYN FUNK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/08/2017
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 W ARBOR DR MC 8895
SAN DIEGO CA
92103-9000
US

IV. Provider business mailing address

925 CHESTNUT ST FL 6
PHILADELPHIA PA
19107-4204
US

V. Phone/Fax

Practice location:
  • Phone: 619-543-1967
  • Fax: 619-543-5521
Mailing address:
  • Phone: 215-955-6056
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Y00000X
TaxonomyOtolaryngology Physician
License NumberMD480835
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: