Healthcare Provider Details

I. General information

NPI: 1750976908
Provider Name (Legal Business Name): KATY FUNG MS, RD, CDN, CSO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/09/2021
Last Update Date: 08/28/2025
Certification Date: 08/28/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

160 E 34TH ST FL 6
NEW YORK NY
10016-4744
US

IV. Provider business mailing address

11047 63RD DR
FOREST HILLS NY
11375-1407
US

V. Phone/Fax

Practice location:
  • Phone: 917-599-8493
  • Fax:
Mailing address:
  • Phone: 917-599-8493
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code133N00000X
TaxonomyNutritionist
License Number009530
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number86072330
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code133VN1301X
TaxonomyOncology Nutrition Registered Dietitian
License Number86072330
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: