Provider Demographics
NPI:1245708163
Name:MOK, TUNG FUNG
Entity type:Individual
Prefix:
First Name:TUNG FUNG
Middle Name:
Last Name:MOK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MELANIE
Other - Middle Name:TUNG FUNG
Other - Last Name:MOK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:15740 WOODRUFF AVE
Mailing Address - Street 2:
Mailing Address - City:BELLFLOWER
Mailing Address - State:CA
Mailing Address - Zip Code:90706-4018
Mailing Address - Country:US
Mailing Address - Phone:562-867-5441
Mailing Address - Fax:562-867-5462
Practice Address - Street 1:15740 WOODRUFF AVE
Practice Address - Street 2:
Practice Address - City:BELLFLOWER
Practice Address - State:CA
Practice Address - Zip Code:90706-4018
Practice Address - Country:US
Practice Address - Phone:562-867-5441
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-08
Last Update Date:2018-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist