Provider Demographics
NPI:1972706166
Name:FUNG, SHUNHANG JOSIAH (RPH)
Entity Type:Individual
Prefix:MR
First Name:SHUNHANG
Middle Name:JOSIAH
Last Name:FUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1808 FLICKINGER AVE
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95131-1919
Mailing Address - Country:US
Mailing Address - Phone:408-926-6902
Mailing Address - Fax:408-258-8152
Practice Address - Street 1:1808 FLICKINGER AVE
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95131-1919
Practice Address - Country:US
Practice Address - Phone:408-926-6902
Practice Address - Fax:408-258-8152
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40613183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist