Provider Demographics
NPI:1144764465
Name:KUNG, FUNG-MING (LAC, RN)
Entity Type:Individual
Prefix:
First Name:FUNG-MING
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
Credentials:LAC, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4909 SE KELLY ST
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97206-2256
Mailing Address - Country:US
Mailing Address - Phone:971-263-6680
Mailing Address - Fax:
Practice Address - Street 1:8283 SW BARBUR BLVD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97219-2871
Practice Address - Country:US
Practice Address - Phone:503-244-1330
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-12-05
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORAC178924171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist