Active NPI
Kevin Shum Fung, DMD
- Dentist
- Lackland Afb, TX
National Provider Identifier
1053014704
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 39903
- Practice address
- 59 DG- Af Postgraduate Dental School
2133 Klinker Street, Building 3352
Lackland Afb, TX 78236-5313 - Phone
- (917) 340-8205
- NPI assigned
- Mar 22, 2023
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 39903 | TX | Primary |
Addresses
Primary practice location
59 DG- Af Postgraduate Dental School
2133 Klinker Street, Building 3352
Lackland Afb, TX 78236-5313
Mailing address
1100 Wilford Hall Loop
Jbsa Lackland, TX 78236-5638
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 39903 | TX | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1679443200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1717545600000",
"number": "1053014704",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1100 WILFORD HALL LOOP",
"city": "JBSA LACKLAND",
"state": "TX",
"postal_code": "782365638"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "59 DG- AF POSTGRADUATE DENTAL SCHOOL",
"address_2": "2133 KLINKER STREET, BUILDING 3352",
"city": "LACKLAND AFB",
"state": "TX",
"postal_code": "782365313",
"telephone_number": "917-340-8205"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SHUM FUNG",
"first_name": "KEVIN",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2023-03-22",
"last_updated": "2024-06-05",
"certification_date": "2024-05-29",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "TX",
"license": "39903",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Lackland Afb, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 5, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.