MEDICARE: VINCENT KIN KEI 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	64365	CA

General Provider Information

NPI Number	:	1386900504
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	VINCENT KIN KEI FUNG D.D.S.

Provider Business Mailing Address
First Line	:	451 BLOSSOM HILL RD STE 20
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1658
Country	:	US
Telephone Number	:	408-337-3659
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 BLOSSOM HILL RD STE 20
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95123-1658
Country	:	US
Telephone Number	:	408-337-3659
Fax Number	:

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

Provider Enumeration Date	:	04/02/2012
Last Update Date	:	10/08/2025

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