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General NPI Number Information
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NPI Number | 1144421637
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Entity Type | Individual
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Provider Name | ROGER K FUNG DDS
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Gender | Male
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Dates
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Enumeration Date | 05/30/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 345 9TH ST SUITE 303
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City | OAKLAND
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State | CA
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Zip | 94607-6522
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Country | US
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Telephone | 510-834-8892
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Fax | 510-834-8813
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Provider Business Mailing Address
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Address Line | 113 BLACKSTONE DR
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City | DANVILLE
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State | CA
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Zip | 94506-1348
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Country | US
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Telephone | 510-834-8892
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Fax | 510-834-8813
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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 | 122300000X
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Taxonomy Name | Dentist
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License Number | DS035721
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License Number State | CA
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