Active NPI
Glenn S Fung, DMD
- Dentist
- Vacaville, CA
National Provider Identifier
1376600205
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 055882
- Practice address
- 885 Markham Ave
Vacaville, CA 95688-2988 - Phone
- (707) 448-8851
- NPI assigned
- Jan 2, 2007
- 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 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 39957 | CA | |
| Dentist | 122300000X | 055882 | NY | Primary |
Addresses
Primary practice location
885 Markham Ave
Vacaville, CA 95688-2988
Mailing address
885 Markham Ave
Vacaville, CA 95688-2988
Phone (707) 448-8851
Other identifiers 2
| Identifier | Type | State | Issuer |
|---|---|---|---|
| B39957-01 | Other | CA | DENTI-CAL |
| 055882 | Other | NY | NEW YORK |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in TX
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 055882 | NY | MD | Dentist |
| 39957 | CA | MD | General Practice Dentistry |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| DHHS IHS Phoenix Area | Dentist | Current | Accepting new patients |
| Glenn S. Fung, DMD., Inc | Dentist | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Dentist
- Vacaville, CA
- NPI 1174775092
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1167696000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1324252800000",
"number": "1376600205",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "885 MARKHAM AVE",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956882988",
"telephone_number": "707-448-8851"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "885 MARKHAM AVE",
"city": "VACAVILLE",
"state": "CA",
"postal_code": "956882988",
"telephone_number": "707-448-8851"
}
],
"practiceLocations": [],
"basic": {
"last_name": "FUNG",
"first_name": "GLENN",
"middle_name": "S",
"name_prefix": "Dr.",
"credential": "DMD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2007-01-02",
"last_updated": "2011-12-19",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "CA",
"license": "39957",
"primary": false
},
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "NY",
"license": "055882",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "DENTI-CAL",
"identifier": "B39957-01",
"state": "CA"
},
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "NEW YORK",
"identifier": "055882",
"state": "NY"
}
],
"endpoints": [],
"other_names": []
}Other providers in Vacaville, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2011; 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.