Edmond K Fung, D.D.S.

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

42469 Issued in CA

Practice address

1500 Tara Hills Dr
Suite 104
Pinole, CA 94564-2577

Phone

(510) 724-2360

Fax

(510) 724-2362

NPI assigned

Jun 12, 2007

Sex

Male

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

Interoperability endpoints

• Direct secure messaging: edmond.fung.p1@direct.snahc.nextgenshare.com

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1181606400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1183852800000",
    "number": "1093919466",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1275 CINNAMON CT",
            "city": "WALNUT CREEK",
            "state": "CA",
            "postal_code": "945966402",
            "telephone_number": "925-944-9873"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1500 TARA HILLS DR",
            "address_2": "SUITE 104",
            "city": "PINOLE",
            "state": "CA",
            "postal_code": "945642577",
            "telephone_number": "510-724-2360",
            "fax_number": "510-724-2362"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNG",
        "first_name": "EDMOND",
        "middle_name": "K",
        "name_prefix": "Mr.",
        "credential": "D.D.S.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2007-06-12",
        "last_updated": "2007-07-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "42469",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Danna Fernandez Hernandez
• Jean Louise Lerit Fernandez
• First Optometric Care of Northern California
• Deanna Belle Flores, IHS
• Yvette Melissa Flores
• Francis Gadayan
• Gary J Gadwood, M.D.
• Gretchen S. Gadwood, D.D.S
• Sandy K Gadwood, D.D.S
• Sabiya Gahatraj

• General Practice Dentistry in Pinole, CA
• Providers in Pinole, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.