Provider Demographics
NPI:1053507228
Name:FUNG, ERNEST (PSYD)
Entity Type:Individual
Prefix:DR
First Name:ERNEST
Middle Name:
Last Name:FUNG
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1255 HILYARD ST
Mailing Address - Street 2:SACRED HEART MEDICAL CENTER
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-3718
Mailing Address - Country:US
Mailing Address - Phone:541-686-7085
Mailing Address - Fax:541-687-4958
Practice Address - Street 1:1255 HILYARD ST
Practice Address - Street 2:SACRED HEART MEDICAL CENTER
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-3718
Practice Address - Country:US
Practice Address - Phone:541-686-7085
Practice Address - Fax:541-687-4958
Is Sole Proprietor?:No
Enumeration Date:2007-09-20
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR2147103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist