Provider Demographics
NPI:1144421637
Name:FUNG, ROGER K (DDS)
Entity Type:Individual
Prefix:DR
First Name:ROGER
Middle Name:K
Last Name:FUNG
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 1:113 BLACKSTONE DR
Mailing Address - Street 2:
Mailing Address - City:DANVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:94506-1348
Mailing Address - Country:US
Mailing Address - Phone:510-834-8892
Mailing Address - Fax:510-834-8813
Practice Address - Street 1:345 9TH ST
Practice Address - Street 2:SUITE 303
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-6522
Practice Address - Country:US
Practice Address - Phone:510-834-8892
Practice Address - Fax:510-834-8813
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADS035721122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist