MEDICARE: DR. KINSUN DAVID FUNG DMD, MS

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	057332	NY

General Provider Information

NPI Number	:	1790123735
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KINSUN DAVID FUNG DMD, MS

Provider Business Mailing Address
First Line	:	10605 JAMAICA AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2016
Country	:	US
Telephone Number	:	718-441-4411
Fax Number	:	718-441-4412

Provider Business Practice Location Address
First Line	:	10605 JAMAICA AVE
Second Line	:
City	:	RICHMOND HILL
State	:	NY
Zip	:	11418-2016
Country	:	US
Telephone Number	:	718-441-4411
Fax Number	:	718-441-4412

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

Provider Enumeration Date	:	06/12/2013
Last Update Date	:	03/31/2022

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