MEDICARE: DR. WAI KEE FUNG D.D.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	22DI02083700	NJ

General Provider Information

NPI Number	:	1366587586
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. WAI KEE FUNG D.D.S.

Provider Business Mailing Address
First Line	:	1614-O UNION VALLEY RD # 310
Second Line	:
City	:	WEST MILFORD
State	:	NJ
Zip	:	07480-2216
Country	:	US
Telephone Number	:	845-595-6288
Fax Number	:	845-595-2275

Provider Business Practice Location Address
First Line	:	215 OLD TAPPAN RD STE 2
Second Line	:
City	:	OLD TAPPAN
State	:	NJ
Zip	:	07675-7000
Country	:	US
Telephone Number	:	201-666-8811
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/02/2023

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