Provider Demographics
NPI:1871519561
Name:FUNG, PETER K (MD)
Entity type:Individual
Prefix:
First Name:PETER
Middle Name:K
Last Name:FUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:235 E BADILLO ST
Mailing Address - Street 2:
Mailing Address - City:COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91723-2116
Mailing Address - Country:US
Mailing Address - Phone:626-915-4700
Mailing Address - Fax:626-214-7815
Practice Address - Street 1:220 S 1ST ST
Practice Address - Street 2:
Practice Address - City:ALHAMBRA
Practice Address - State:CA
Practice Address - Zip Code:91801-3700
Practice Address - Country:US
Practice Address - Phone:626-281-8663
Practice Address - Fax:626-281-6318
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG53944207RI0011X, 207RC0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RI0011XAllopathic & Osteopathic PhysiciansInternal MedicineInterventional Cardiology
No207RC0000XAllopathic & Osteopathic PhysiciansInternal MedicineCardiovascular Disease
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G539440Medicaid
CA109922OtherABIM INTERVENTIONAL CARDIOLOGY
CAWG53944CMedicare PIN