Provider Demographics
NPI:1003919275
Name:FUNADA, RAYMOND (DDS)
Entity Type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:
Last Name:FUNADA
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2000 FOREST AVE
Mailing Address - Street 2:STE C
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4831
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2000 FOREST AVE
Practice Address - Street 2:STE C
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4831
Practice Address - Country:US
Practice Address - Phone:408-287-5900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA379651223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA609294OtherUNITED CONCORDIA