Provider Demographics
NPI:1376924829
Name:FUNG, IRIS (AUD)
Entity Type:Individual
Prefix:
First Name:IRIS
Middle Name:
Last Name:FUNG
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2200 NW MYHRE RD
Mailing Address - Street 2:
Mailing Address - City:SILVERDALE
Mailing Address - State:WA
Mailing Address - Zip Code:98383-7681
Mailing Address - Country:US
Mailing Address - Phone:360-830-1100
Mailing Address - Fax:360-830-1385
Practice Address - Street 1:2200 NW MYHRE RD
Practice Address - Street 2:
Practice Address - City:SILVERDALE
Practice Address - State:WA
Practice Address - Zip Code:98383-7681
Practice Address - Country:US
Practice Address - Phone:360-830-1100
Practice Address - Fax:360-830-1385
Is Sole Proprietor?:No
Enumeration Date:2015-06-10
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALD60573570231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAP01527864OtherRR PTAN
WA344823OtherLNI
WA20461882Medicaid
WA344823OtherLNI