Provider Demographics
NPI:1881810927
Name:FUNG, ELLEN B (PHD, RD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
Middle Name:B
Last Name:FUNG
Suffix:
Gender:F
Credentials:PHD, RD
Other - Prefix:
Other - First Name:ELLEN
Other - Middle Name:J
Other - Last Name:BIEHL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6618 DOVER ST
Mailing Address - Street 2:
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94609-1012
Mailing Address - Country:US
Mailing Address - Phone:510-428-3885
Mailing Address - Fax:510-450-5877
Practice Address - Street 1:5700 MARTIN LUTHER KING JR WAY
Practice Address - Street 2:HEDCO HEALTH SCIENCE CENTER
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94609-1673
Practice Address - Country:US
Practice Address - Phone:510-428-3885
Practice Address - Fax:510-450-5877
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA836890133V00000X
CARHP814702471B0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered133V00000XDietary & Nutritional Service ProvidersDietitian, Registered
Not Answered2471B0102XTechnologists, Technicians & Other Technical Service ProvidersRadiologic TechnologistBone Densitometry