Provider Demographics
NPI:1497005912
Name:FUNG, STEPHANIE S (DDS)
Entity Type:Individual
Prefix:DR
First Name:STEPHANIE
Middle Name:S
Last Name:FUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3480 GRANADA AVE
Mailing Address - Street 2:APT 102
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051-3478
Mailing Address - Country:US
Mailing Address - Phone:630-337-8587
Mailing Address - Fax:
Practice Address - Street 1:877 W FREMONT AVE
Practice Address - Street 2:SUITE L3
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94087-2315
Practice Address - Country:US
Practice Address - Phone:408-245-7500
Practice Address - Fax:408-746-5820
Is Sole Proprietor?:No
Enumeration Date:2012-09-12
Last Update Date:2012-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608141223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice