Provider Demographics
NPI:1538441118
Name:FUNG, JONATHAN ZADOK (DDS)
Entity type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ZADOK
Last Name:FUNG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6280 JACKSON DR
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92119-3434
Mailing Address - Country:US
Mailing Address - Phone:619-464-4346
Mailing Address - Fax:
Practice Address - Street 1:6280 JACKSON DR
Practice Address - Street 2:SUITE 6
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92119-3434
Practice Address - Country:US
Practice Address - Phone:619-464-4346
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-09
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA606751223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice