Provider Demographics
NPI:1225079205
Name:FUNG, BARRY YP (MD)
Entity Type:Individual
Prefix:
First Name:BARRY
Middle Name:YP
Last Name:FUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2449 S KING RD
Mailing Address - Street 2:STE 10
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95122-1811
Mailing Address - Country:US
Mailing Address - Phone:408-238-1978
Mailing Address - Fax:
Practice Address - Street 1:4906 EL CAMINO REAL
Practice Address - Street 2:STE B
Practice Address - City:LOS ALTOS
Practice Address - State:CA
Practice Address - Zip Code:94022-1449
Practice Address - Country:US
Practice Address - Phone:650-967-7834
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2016-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA70770207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA7180235Medicaid
CA00A707700Medicare PIN
CAG29613Medicare UPIN