Provider Demographics
NPI:1265605125
Name:FUNG, STEPHANIE KO (PHARMD)
Entity type:Individual
Prefix:
First Name:STEPHANIE
Middle Name:KO
Last Name:FUNG
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:STEPHANIE
Other - Middle Name:WAI-MUN
Other - Last Name:KO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1100 VETERANS BLVD FL 3
Mailing Address - Street 2:
Mailing Address - City:REDWOOD CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94063-2037
Mailing Address - Country:US
Mailing Address - Phone:650-299-3567
Mailing Address - Fax:
Practice Address - Street 1:1100 VETERANS BLVD FL 3
Practice Address - Street 2:
Practice Address - City:REDWOOD CITY
Practice Address - State:CA
Practice Address - Zip Code:94063-2037
Practice Address - Country:US
Practice Address - Phone:650-299-3567
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-04-10
Last Update Date:2021-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60676183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist