Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 111NN0400X | Neurology | DC25007 | CA |
Y | 111NN1001X | Nutrition | DC25007 | CA |
NPI | 1083039374 |
---|---|
Provider Name | Dr. Gary Kingman Fung |
First Address | San Francisco, CA 94128-1825 |
Second Address | Burlingame, CA 94010-1505 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 24/02/2014 |
Last Update Date | 24/02/2014 |