Edmond Fung, D.C.

Primary specialty

ChiropractorTaxonomy code 111N00000X

License

DC25236 Issued in CA

Practice address

415 N San Mateo Dr
San Mateo, CA 94401-2493

Phone

(650) 685-8883

NPI assigned

Apr 14, 2008

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

Other identifiers 1

Other names 1

• Edmond Y. Fung Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Practice roles

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.

• Fung Chiropractic

  • Chiropractor
  • San Mateo, CA
  • NPI 1619053634
  NPD (past) Authorized official

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

{
    "created_epoch": "1208131200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1208131200000",
    "number": "1972777696",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "415 N SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012493",
            "telephone_number": "650-685-8883"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 N SAN MATEO DR",
            "city": "SAN MATEO",
            "state": "CA",
            "postal_code": "944012493",
            "telephone_number": "650-685-8883"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "FUNG",
        "first_name": "EDMOND",
        "credential": "D.C.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2008-04-14",
        "last_updated": "2008-04-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "",
            "desc": "Chiropractor",
            "state": "CA",
            "license": "DC25236",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE SHIELD",
            "identifier": "DC0252360",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "EDMOND",
            "last_name": "FUNG",
            "middle_name": "Y.",
            "credential": "D.C.",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

• Diana Fuentes
• Jose Rafael Fuentes Jr.
• Daniele Fuller
• Kelsey Fuller, LCSW
• Fung Chiropractic
• Rebecca Fung, LAC
• Tracey M Fung, D.C.
• Madelynne Rae Gabriele
• Raymond R Gaeta, M.D.
• Robin Staci Gaffke Villavicencio, BA, ATC

• Chiropractor in San Mateo, CA
• Providers in San Mateo, CA by specialty
• Chiropractor in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 14, 2008; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.