MEDICARE: HENRY HANG-YEE FUNG, D.D.S. INC.

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	1223S0112X	Oral and Maxillofacial Surgery (Dentist)	30354	CA
2	1223G0001X	General Practice Dentistry	30354	CA
3	171100000X	Acupuncturist	AC001426	CA
4	122300000X	Dentist	30354	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	DA0247431	OTHER	CA	BLUE CROSS
2	700367	OTHER	CA	UNITED CONCORDIA
3	G93969-01	OTHER	CA	MEDI-CAL
4	D30354	OTHER	CA	MEDI-CAL
6	ZZZ11029Z	OTHER	CA	BLUE CROSS

General Provider Information

NPI Number	:	1497716930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HENRY HANG-YEE FUNG, D.D.S. INC.

Provider Business Mailing Address
First Line	:	5424 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2208
Country	:	US
Telephone Number	:	323-721-3312
Fax Number	:	323-721-8822

Provider Business Practice Location Address
First Line	:	5424 E BEVERLY BLVD
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90022-2208
Country	:	US
Telephone Number	:	323-721-3312
Fax Number	:	323-721-8822

Authorized Official
Title or Position	:	MANAGER
Name	:	MARGARET FUNG
Credential	:
Telephone Number	:	323-721-3312

Provider Enumeration Date	:	03/31/2006
Last Update Date	:	05/28/2008

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