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General NPI Number Information
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NPI Number | 1407609779
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Entity Type | Organization
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Legal Business Name | PACIFIC DERMATOLOGY INC
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Dates
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Enumeration Date | 04/08/2024
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Last Update Date | 04/08/2024
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Provider Practice Location Address
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Address Line | 5924 STONERIDGE DR STE 101
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City | PLEASANTON
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State | CA
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Zip | 94588-2750
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Country | US
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Telephone | 925-426-8828
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Fax | 925-426-8812
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Provider Business Mailing Address
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Address Line | 5924 STONERIDGE DR STE 101
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City | PLEASANTON
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State | CA
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Zip | 94588-2750
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Country | US
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Telephone | 925-426-8828
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Fax | 925-426-8812
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Authorized Official
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Title or Position | MD/OWNER
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Name | DR. HANK KWONG FUNG
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Credential | MD
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Telephone | 925-426-8828
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207N00000X
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Taxonomy Name | Dermatology Physician
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License Number |
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License Number State |
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