Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213ES0103X | Foot & Ankle Surgery | SC006917 | PA |
NPI | 1053806232 |
---|---|
Provider Name | Christopher Ryan Fung |
First Address | Bryn Mawr, PA 19010-1530 |
Second Address | Bryn Mawr, PA 19010-3121 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/06/2018 |
Last Update Date | 28/06/2018 |