Healthcare Provider Details

I. General information

NPI: 1962449538
Provider Name (Legal Business Name): PETER C FUNG M.D., F.A.C.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/01/2006
Last Update Date: 03/31/2015
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: 408-738-9730
Mailing address:
  • Phone: 408-738-9728
  • Fax: 408-738-9730

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084V0102X
TaxonomyVascular Neurology Physician
License NumberA30723
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: