| Organization Name: | WILSON FUNG MD INC |
| NPI Number: | 1154613024 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | HOLLY LANDIS (OFFICE MANAGER) |
| Mailing Address: | 2412 N Ponderosa Dr B103 Camarillo |
| State: | CA US |
| Postal Code: | 930102373 |
| Phone Number: | 8054841190 |
| Fax Number: | 8054841154 |
| NPI Enumeration Date: | 05/10/2011 |
| NPI Last Update Date: | 05/10/2011 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 208D00000X |
| License Number: | G69969 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Allopathic & Osteopathic Physicians |
| Taxonomy Classification: | General Practice |
| Taxonomy Specialization: | |
| Taxonomy Definition: | |