Provider Demographics
NPI:1477926632
Name:PUN, MAN WAI
Entity Type:Individual
Prefix:
First Name:MAN WAI
Middle Name:
Last Name:PUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10455 S DE ANZA BLVD
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3011
Mailing Address - Country:US
Mailing Address - Phone:408-996-1911
Mailing Address - Fax:
Practice Address - Street 1:10133 S DE ANZA BLVD STE B
Practice Address - Street 2:
Practice Address - City:CUPERTINO
Practice Address - State:CA
Practice Address - Zip Code:95014-2126
Practice Address - Country:US
Practice Address - Phone:408-899-4199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-11-09
Last Update Date:2019-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA65488183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist