Provider Demographics
NPI:1639559834
Name:FUNG, KEITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KEITH
Middle Name:
Last Name:FUNG
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2801 SEPULVEDA BLVD UNIT 119
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-2866
Mailing Address - Country:US
Mailing Address - Phone:310-328-7063
Mailing Address - Fax:
Practice Address - Street 1:1050 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:SAN PEDRO
Practice Address - State:CA
Practice Address - Zip Code:90732-2428
Practice Address - Country:US
Practice Address - Phone:310-833-3225
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-02
Last Update Date:2015-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48841183500000X
NV13075183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist