Provider Demographics
NPI:1316764301
Name:FUNG-ON, SEAN (DNP, APRN, FNP-C, RN)
Entity type:Individual
Prefix:
First Name:SEAN
Middle Name:
Last Name:FUNG-ON
Suffix:
Gender:M
Credentials:DNP, APRN, FNP-C, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1984 W EL CAMINO REAL APT 426
Mailing Address - Street 2:
Mailing Address - City:MOUNTAIN VIEW
Mailing Address - State:CA
Mailing Address - Zip Code:94040-2298
Mailing Address - Country:US
Mailing Address - Phone:954-226-9364
Mailing Address - Fax:
Practice Address - Street 1:1604 BLOSSOM HILL RD STE 10
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95124-6350
Practice Address - Country:US
Practice Address - Phone:408-528-8833
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-09-23
Last Update Date:2024-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95031632207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine