Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RC0001X | Clinical Cardiac Electrophysiologist | 0422298 | KS |
Y | 207RC0001X | Clinical Cardiac Electrophysiologist | R3G95 | MO |
NPI | 1023062643 |
---|---|
Provider Name | Dr. Robert Tian-Run Tung |
First Address | Kansas City, MO 64184-3769 |
Second Address | Kansas City, MO 64114-4855 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 19/05/2006 |
Last Update Date | 06/11/2012 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0004379682 | AETNA (01) | |
0004379682 | AETNA HMO (01) | |
0004379682 | AETNA PPO (01) | |
060035078 | MEDICARE RAILROAD (01) | |
1023062643 | (05) | MO |
C52331 | (02) | |
P00319339 | MEDICARE RAILROAD (01) | MO |