Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 95000299 | CA |
NPI | 1003239997 |
---|---|
Provider Name | Lisa Cung |
First Address | San Leandro, CA 94577-4211 |
Second Address | San Leandro, CA 94577-4211 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 28/01/2014 |
Last Update Date | 04/04/2016 |