Provider Demographics
NPI:1356365050
Name:PETER C. FUNG, M.D., INC.
Entity type:Organization
Organization Name:PETER C. FUNG, M.D., INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:C
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD, FACP, FAAN
Authorized Official - Phone:408-738-9728
Mailing Address - Street 1:1208 E ARQUES AVE STE 113
Mailing Address - Street 2:
Mailing Address - City:SUNNYVALE
Mailing Address - State:CA
Mailing Address - Zip Code:94085-5419
Mailing Address - Country:US
Mailing Address - Phone:408-738-9728
Mailing Address - Fax:408-738-9730
Practice Address - Street 1:1208 E ARQUES AVE
Practice Address - Street 2:SUITE 113
Practice Address - City:SUNNYVALE
Practice Address - State:CA
Practice Address - Zip Code:94085-5418
Practice Address - Country:US
Practice Address - Phone:408-738-9728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-26
Last Update Date:2015-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA307232084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA26206Medicare UPIN
CAZZZ05850ZMedicare PIN