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Individual
DR. GLENN S FUNG
Active
Individual
DR. GLENN S FUNG
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DMD
Taxonomy
Speciality
Code
Description
License number
State
122300000X
Dentist
Primary
055882
NY
1223G0001X
General Practice Dentistry
39957
CA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
055882
NEW YORK
NY
01
—
B39957-01
DENTI-CAL
CA
Enumeration date
01/02/2007
Last updated
12/19/2011
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