Provider Demographics
NPI:1285770529
Name:LIT K. FUNG, M.D., INC., A PROFESSIONAL MEDICAL CORPORATION
Entity type:Organization
Organization Name:LIT K. FUNG, M.D., INC., A PROFESSIONAL MEDICAL CORPORATION
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:LIT
Authorized Official - Middle Name:K
Authorized Official - Last Name:FUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-572-4222
Mailing Address - Street 1:1501 OAKDALE RD STE 218
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-3382
Mailing Address - Country:US
Mailing Address - Phone:209-572-4222
Mailing Address - Fax:209-572-4272
Practice Address - Street 1:1501 OAKDALE RD STE 218
Practice Address - Street 2:
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3382
Practice Address - Country:US
Practice Address - Phone:209-572-4222
Practice Address - Fax:209-572-4272
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59878208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAP00014379OtherRAILROAD MEDICARE
CA8503333Medicaid
CAZZZ22746ZMedicare PIN