=====================================================
General NPI Number Information
=====================================================
NPI Number | 1548786064
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DAVIDS DENTISTRY PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/16/2017
-----------------------------------------------------
Last Update Date | 07/21/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10605 JAMAICA AVE
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-2016
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-441-4411
-----------------------------------------------------
Fax | 718-441-4412
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10911 JAMAICA AVE
-----------------------------------------------------
City | RICHMOND HILL
-----------------------------------------------------
State | NY
-----------------------------------------------------
Zip | 11418-2335
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 718-441-4411
-----------------------------------------------------
Fax | 718-441-4412
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. KINSUN DAVID FUNG
-----------------------------------------------------
Credential | DMD, MS
-----------------------------------------------------
Telephone | 718-441-4411
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1223G0001X
-----------------------------------------------------
Taxonomy Name | General Practice Dentistry
-----------------------------------------------------
License Number | 057332
-----------------------------------------------------
License Number State | NY
-----------------------------------------------------