Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0000X | Hematologist | 036113770 | IL |
Y | 207RH0003X | Hematology & Oncology | MD450472 | PA |
NPI | 1215997085 |
---|---|
Provider Name | Henry Fung |
First Address | Philadelphia, PA 19129-1302 |
Second Address | Philadelphia, PA 19111-2434 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/03/2006 |
Last Update Date | 20/12/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
G16740 | (02) | IL |