Provider Demographics
NPI:1932104718
Name:FUNG, BARNETT KAI LUNG (DPM)
Entity Type:Individual
Prefix:DR
First Name:BARNETT
Middle Name:KAI LUNG
Last Name:FUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2553 W PETERSON AVE
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60659-4019
Mailing Address - Country:US
Mailing Address - Phone:773-784-8807
Mailing Address - Fax:773-784-1056
Practice Address - Street 1:2553 W PETERSON AVE
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60659-4019
Practice Address - Country:US
Practice Address - Phone:773-784-8807
Practice Address - Fax:773-784-1056
Is Sole Proprietor?:Yes
Enumeration Date:2005-06-17
Last Update Date:2010-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016004595213E00000X, 213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist
No213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILU32416Medicare UPIN
IL979650Medicare ID - Type Unspecified