Provider Demographics
NPI:1689830879
Name:FUNG, EDWARD LI-YU (JD, DDS)
Entity Type:Individual
Prefix:DR
First Name:EDWARD
Middle Name:LI-YU
Last Name:FUNG
Suffix:
Gender:M
Credentials:JD, DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1089 JORDAN CREEK PKWY
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50266-5829
Mailing Address - Country:US
Mailing Address - Phone:515-224-5999
Mailing Address - Fax:
Practice Address - Street 1:1089 JORDAN CREEK PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50266-5829
Practice Address - Country:US
Practice Address - Phone:515-224-5999
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-06
Last Update Date:2008-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA7962122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist