Individual
GLORY FUNG
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
ATC
Contact information
Practice address
1530 CONCORDIA, IRVINE, CA 92612-3203
(949) 214-3245
Mailing address
1530 CONCORDIA, IRVINE, CA 92612-3203
(949) 214-3245
Taxonomy
Speciality
Code
Description
License number
State
2255A2300X
Athletic Trainer
Primary
070302088
CA
Other
Enumeration date
10/08/2014
Last updated
10/08/2014
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