Provider Demographics
NPI:1619173127
Name:FUNG, DANIEL ANHUA (MD)
Entity Type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:ANHUA
Last Name:FUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Mailing Address - Street 1:2811 WILSHIRE BLVD
Mailing Address - Street 2:SUITE 850
Mailing Address - City:SANTA MONICA
Mailing Address - State:CA
Mailing Address - Zip Code:90403-4803
Mailing Address - Country:US
Mailing Address - Phone:310-828-7757
Mailing Address - Fax:310-828-6687
Practice Address - Street 1:2811 WILSHIRE BLVD
Practice Address - Street 2:SUITE 850
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90403-4803
Practice Address - Country:US
Practice Address - Phone:310-828-7757
Practice Address - Fax:310-828-6687
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-22
Last Update Date:2012-07-26
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA107358208100000X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain Medicine