Provider Demographics
NPI:1497106199
Name:FUNG, KATHARINA S (DMD)
Entity type:Individual
Prefix:
First Name:KATHARINA
Middle Name:S
Last Name:FUNG
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2125 GREEN VISTA DR STE 104
Mailing Address - Street 2:
Mailing Address - City:SPARKS
Mailing Address - State:NV
Mailing Address - Zip Code:89431-8515
Mailing Address - Country:US
Mailing Address - Phone:775-674-1444
Mailing Address - Fax:775-674-1515
Practice Address - Street 1:2125 GREEN VISTA DR STE 104
Practice Address - Street 2:
Practice Address - City:SPARKS
Practice Address - State:NV
Practice Address - Zip Code:89431-8515
Practice Address - Country:US
Practice Address - Phone:775-674-1444
Practice Address - Fax:775-674-1515
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-24
Last Update Date:2024-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL0190321681223X0400X
MADN18573111223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics