Provider Demographics
NPI:1407609779
Name:PACIFIC DERMATOLOGY INC
Entity Type:Organization
Organization Name:PACIFIC DERMATOLOGY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HANK
Authorized Official - Middle Name:KWONG
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-426-8828
Mailing Address - Street 1:5924 STONERIDGE DR STE 101
Mailing Address - Street 2:
Mailing Address - City:PLEASANTON
Mailing Address - State:CA
Mailing Address - Zip Code:94588-2750
Mailing Address - Country:US
Mailing Address - Phone:925-426-8828
Mailing Address - Fax:925-426-8812
Practice Address - Street 1:5924 STONERIDGE DR STE 101
Practice Address - Street 2:
Practice Address - City:PLEASANTON
Practice Address - State:CA
Practice Address - Zip Code:94588-2750
Practice Address - Country:US
Practice Address - Phone:925-426-8828
Practice Address - Fax:925-426-8812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty