Provider Demographics
NPI:1144416249
Name:FUNG, SHIRLIEY (LAC, MACOM)
Entity Type:Individual
Prefix:
First Name:SHIRLIEY
Middle Name:
Last Name:FUNG
Suffix:
Gender:F
Credentials:LAC, MACOM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16860 SE 171ST PL
Mailing Address - Street 2:
Mailing Address - City:RENTON
Mailing Address - State:WA
Mailing Address - Zip Code:98058-4200
Mailing Address - Country:US
Mailing Address - Phone:206-550-5206
Mailing Address - Fax:
Practice Address - Street 1:8009 S 180TH ST
Practice Address - Street 2:#104
Practice Address - City:KENT
Practice Address - State:WA
Practice Address - Zip Code:98032-1042
Practice Address - Country:US
Practice Address - Phone:206-550-5206
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-21
Last Update Date:2007-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAC00002909171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist