Healthcare Provider Details

I. General information

NPI: 1356365050
Provider Name (Legal Business Name): PETER C. FUNG, M.D., INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2006
Last Update Date: 08/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1208 E ARQUES AVE SUITE 113
SUNNYVALE CA
94085-5418
US

IV. Provider business mailing address

1208 E ARQUES AVE STE 113
SUNNYVALE CA
94085-5419
US

V. Phone/Fax

Practice location:
  • Phone: 408-738-9728
  • Fax:
Mailing address:
  • Phone: 408-738-9728
  • Fax: 408-738-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA30723
License Number StateCA

VIII. Authorized Official

Name: DR. PETER C. FUNG
Title or Position: PRESIDENT
Credential: M.D., FACP, FAAN
Phone: 408-738-9728