1669654497 NPI number — HING-SHEUNG EUGENE FUNG MD PA

Table of content: (NPI 1669654497)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669654497 NPI number — HING-SHEUNG EUGENE FUNG MD PA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HING-SHEUNG EUGENE FUNG MD PA
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

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:
1669654497
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2911 HERRING AVE
Provider Second Line Business Mailing Address:
SUITE 306
Provider Business Mailing Address City Name:
WACO
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
76708-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
254-755-4582
Provider Business Mailing Address Fax Number:
254-755-4585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2911 HERRING AVE
Provider Second Line Business Practice Location Address:
SUITE 306
Provider Business Practice Location Address City Name:
WACO
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76708-3245
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
254-755-4582
Provider Business Practice Location Address Fax Number:
254-755-4585
Provider Enumeration Date:
12/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
FUNG
Authorized Official First Name:
HING-SHEUNG
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
PHYSICIAN
Authorized Official Telephone Number:
254-755-4582

Provider Taxonomy Codes

  • Taxonomy code: 207RR0500X , with the licence number:  J1249 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 00291U . This is a "REINSTATED MEDICARE GROUP#" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: J1249 . This is a "TXB LICENSE" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".
  • Identifier: A0082541 . This is a "DPS #" identifier , issued by the state of ( TX ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com