Healthcare Provider Details

I. General information

NPI: 1033129127
Provider Name (Legal Business Name): FREDERICK Y FUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2006
Last Update Date: 06/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

300 FIR ST
SAN DIEGO CA
92101-2327
US

IV. Provider business mailing address

300 FIR ST
SAN DIEGO CA
92101-2327
US

V. Phone/Fax

Practice location:
  • Phone: 619-446-1510
  • Fax: 619-446-1514
Mailing address:
  • Phone: 619-446-1510
  • Fax: 619-446-1514

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2083T0002X
TaxonomyMedical Toxicology (Preventive Medicine) Physician
License NumberA40644
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code2083X0100X
TaxonomyOccupational Medicine Physician
License NumberA40644
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: