Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223G0001X | General Practice | 106175 | CA |
Y | 213EG0000X | General Practice | 106175 | CA |
NPI | 1003486473 |
---|---|
Provider Name | Kristen Zung |
First Address | Saratoga, CA 95070-5734 |
Second Address | Saratoga, CA 95070 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/06/2021 |
Last Update Date | 29/06/2021 |