Provider Demographics
NPI:1275673790
Name:GREGORY FUNG MD INC
Entity Type:Organization
Organization Name:GREGORY FUNG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-982-6691
Mailing Address - Street 1:789 VALLEJO STREET
Mailing Address - Street 2:
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94133-3834
Mailing Address - Country:US
Mailing Address - Phone:415-982-6691
Mailing Address - Fax:415-982-0914
Practice Address - Street 1:789 VALLEJO STREET
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94133-3834
Practice Address - Country:US
Practice Address - Phone:415-982-6691
Practice Address - Fax:415-982-0914
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG41709207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G417090Medicaid
CA00G417090Medicaid