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General NPI Number Information
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NPI Number | 1093919466
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Entity Type | Individual
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Provider Name | EDMOND K FUNG D.D.S.
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Gender | Male
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Dates
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Enumeration Date | 06/12/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 1500 TARA HILLS DR SUITE 104
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City | PINOLE
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State | CA
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Zip | 94564-2577
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Country | US
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Telephone | 510-724-2360
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Fax | 510-724-2362
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Provider Business Mailing Address
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Address Line | 1275 CINNAMON CT
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City | WALNUT CREEK
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State | CA
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Zip | 94596-6402
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Country | US
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Telephone | 925-944-9873
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | 42469
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License Number State | CA
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