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General NPI Number Information
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NPI Number | 1053806232
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Entity Type | Individual
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Provider Name | CHRISTOPHER RYAN FUNG DPM
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Gender | Male
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Dates
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Enumeration Date | 06/28/2018
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Last Update Date | 06/28/2018
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Provider Practice Location Address
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Address Line | 130 S BRYN MAWR AVE
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City | BRYN MAWR
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State | PA
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Zip | 19010-3121
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Country | US
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Telephone | 484-337-3000
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Fax |
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Provider Business Mailing Address
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Address Line | 1000 CONESTOGA RD APT A102
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City | BRYN MAWR
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State | PA
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Zip | 19010-1530
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Country | US
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Telephone | 714-651-5242
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 213ES0103X
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Taxonomy Name | Foot & Ankle Surgery Podiatrist
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License Number | SC006917
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License Number State | PA
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