Provider Demographics
NPI:1477542256
Name:HUNG, FAI (OD)
Entity Type:Individual
Prefix:
First Name:FAI
Middle Name:
Last Name:HUNG
Suffix:
Gender:M
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22154 58TH AVE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-1943
Mailing Address - Country:US
Mailing Address - Phone:718-225-1630
Mailing Address - Fax:718-233-3368
Practice Address - Street 1:151 E BROADWAY
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002-6301
Practice Address - Country:US
Practice Address - Phone:212-233-6688
Practice Address - Fax:212-233-3368
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYT004248152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00760509Medicaid
T32077Medicare UPIN