Provider Demographics
NPI:1346240264
Name:FUNG, LIT KEUNG (MD)
Entity type:Individual
Prefix:
First Name:LIT
Middle Name:KEUNG
Last Name:FUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COFFEE RD
Mailing Address - Street 2:
Mailing Address - City:MODESTO
Mailing Address - State:CA
Mailing Address - Zip Code:95355-4201
Mailing Address - Country:US
Mailing Address - Phone:209-524-1211
Mailing Address - Fax:
Practice Address - Street 1:1501 OAKDALE RD
Practice Address - Street 2:SUITE 218
Practice Address - City:MODESTO
Practice Address - State:CA
Practice Address - Zip Code:95355-3381
Practice Address - Country:US
Practice Address - Phone:209-572-4222
Practice Address - Fax:209-572-4272
Is Sole Proprietor?:No
Enumeration Date:2005-07-21
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG59878208G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208G00000XAllopathic & Osteopathic PhysiciansThoracic Surgery (Cardiothoracic Vascular Surgery)
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAY019YMedicare PIN