MEDICARE: MR. SHUNHANG JOSIAH FUNG R.PH

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	183500000X	Pharmacist	40613	CA

General Provider Information

NPI Number	:	1972706166
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. SHUNHANG JOSIAH FUNG R.PH

Provider Business Mailing Address
First Line	:	1808 FLICKINGER AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1919
Country	:	US
Telephone Number	:	408-926-6902
Fax Number	:	408-258-8152

Provider Business Practice Location Address
First Line	:	1808 FLICKINGER AVE
Second Line	:
City	:	SAN JOSE
State	:	CA
Zip	:	95131-1919
Country	:	US
Telephone Number	:	408-926-6902
Fax Number	:	408-258-8152

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

Provider Enumeration Date	:	06/06/2007
Last Update Date	:	07/08/2007

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