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General NPI Number Information
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NPI Number | 1619053634
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Entity Type | Organization
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Legal Business Name | FUNG CHIROPRACTIC
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Dates
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Enumeration Date | 10/31/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 415 N SAN MATEO DR SUITE 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2494
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Country | US
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Telephone | 650-685-8883
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Fax |
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Provider Business Mailing Address
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Address Line | 415 N SAN MATEO DR SUITE 2
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City | SAN MATEO
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State | CA
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Zip | 94401-2494
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Country | US
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Telephone | 650-685-8883
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | EDMOND Y FUNG
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Credential | D.C.
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Telephone | 650-685-8883
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 111N00000X
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Taxonomy Name | Chiropractor
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License Number | DC25236
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License Number State | CA
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