Provider Demographics
NPI:1225186620
Name:LAM, FUNG (MD)
Entity type:Individual
Prefix:DR
First Name:FUNG
Middle Name:
Last Name:LAM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1725 MONTGOMERY ST
Mailing Address - Street 2:SUITE #200
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94111-1030
Mailing Address - Country:US
Mailing Address - Phone:415-831-2180
Mailing Address - Fax:415-398-2696
Practice Address - Street 1:1725 MONTGOMERY ST
Practice Address - Street 2:SUITE #200
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94111-1030
Practice Address - Country:US
Practice Address - Phone:415-831-2180
Practice Address - Fax:415-398-2696
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2013-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG48352174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA51017Medicare UPIN