1821658873 NPI number — MR. PETER WILLIAM IP FUNG CHUN MD

Table of content: MR. PETER WILLIAM IP FUNG CHUN MD (NPI 1821658873)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1821658873 NPI number — MR. PETER WILLIAM IP FUNG CHUN MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
IP FUNG CHUN
Provider First Name:
PETER
Provider Middle Name:
WILLIAM
Provider Name Prefix Text:
MR.
Provider Name Suffix Text:
Provider Credential Text:
MD
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1821658873
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
02/05/2020
NPI Reactivation Date:
07/01/2020

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1001 MAIN STREET, ROOM 5145
Provider Second Line Business Mailing Address:
DIVISION OF PEDIATRIC MEDICAL EDUCATION
Provider Business Mailing Address City Name:
BUFFALO
Provider Business Mailing Address State Name:
NY
Provider Business Mailing Address Postal Code:
14203
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
647-608-2983
Provider Business Mailing Address Fax Number:
416-583-2442

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1001 MAIN STREET, ROOM 5145
Provider Second Line Business Practice Location Address:
DIVISION OF PEDIATRIC MEDICAL EDUCATION
Provider Business Practice Location Address City Name:
BUFFALO
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
14203
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
647-608-2983
Provider Business Practice Location Address Fax Number:
416-583-2442
Provider Enumeration Date:
06/20/2019

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 390200000X , registered in the state of NY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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