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General NPI Number Information
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NPI Number | 1154613024
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Entity Type | Organization
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Legal Business Name | WILSON FUNG MD INC
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Dates
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Enumeration Date | 05/10/2011
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Last Update Date | 05/10/2011
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Provider Practice Location Address
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Address Line | 2412 N PONDEROSA DR B103
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City | CAMARILLO
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State | CA
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Zip | 93010-2373
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Country | US
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Telephone | 805-484-1190
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Fax | 805-484-1154
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Provider Business Mailing Address
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Address Line | 2412 N PONDEROSA DR B103
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City | CAMARILLO
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State | CA
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Zip | 93010-2373
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Country | US
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Telephone | 805-484-1190
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Fax | 805-484-1154
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | HOLLY LANDIS
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Credential |
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Telephone | 805-484-1190
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number | G69969
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License Number State | CA
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