Provider Demographics
NPI:1699846659
Name:NGAN, FUNG (MD)
Entity Type:Individual
Prefix:
First Name:FUNG
Middle Name:
Last Name:NGAN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 EAST BROADWAY
Mailing Address - Street 2:#401
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10002
Mailing Address - Country:US
Mailing Address - Phone:212-406-7379
Mailing Address - Fax:212-406-7378
Practice Address - Street 1:17 EAST BROADWAY
Practice Address - Street 2:#401
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10002
Practice Address - Country:US
Practice Address - Phone:212-406-7379
Practice Address - Fax:212-406-7378
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-13
Last Update Date:2012-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY204389207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01856360Medicaid
41C151Medicare ID - Type Unspecified
NY01856360Medicaid