Provider Demographics
NPI:1821658873
Name:IP FUNG CHUN, PETER WILLIAM (MD)
Entity Type:Individual
Prefix:MR
First Name:PETER
Middle Name:WILLIAM
Last Name:IP FUNG CHUN
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 1:1001 MAIN STREET, ROOM 5145
Mailing Address - Street 2:DIVISION OF PEDIATRIC MEDICAL EDUCATION
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14203
Mailing Address - Country:US
Mailing Address - Phone:647-608-2983
Mailing Address - Fax:416-583-2442
Practice Address - Street 1:1001 MAIN STREET, ROOM 5145
Practice Address - Street 2:DIVISION OF PEDIATRIC MEDICAL EDUCATION
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14203
Practice Address - Country:US
Practice Address - Phone:647-608-2983
Practice Address - Fax:416-583-2442
Is Sole Proprietor?:No
Enumeration Date:2019-06-20
Last Update Date:2020-07-01
Deactivation Date:2020-02-05
Deactivation Code:
Reactivation Date:2020-07-01
Provider Licenses
StateLicense IDTaxonomies
NY390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program