Provider Demographics
NPI:1902192701
Name:FUNG, KA WING
Entity Type:Individual
Prefix:
First Name:KA WING
Middle Name:
Last Name:FUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1325 E FOXHILL DR APT 230
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93720-5002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5740 N BLACKSTONE AVE
Practice Address - Street 2:T1417
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5006
Practice Address - Country:US
Practice Address - Phone:559-431-8650
Practice Address - Fax:559-431-8650
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-21
Last Update Date:2011-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA63574183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist