Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207R00000X | Internist | G44657 | CA |
Y | 111NI0900X | Internist | G44657 | CA |
N | 207RA0201X | Internist - Allergy & Immunology | G44657 | CA |
N | 207RP1001X | Pulmonary Disease | G44657 | CA |
NPI | 1841375425 |
---|---|
Provider Name | Ronald Tung |
First Address | Northridge, CA 91325-4108 |
Second Address | Northridge, CA 91325-4108 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/10/2006 |
Last Update Date | 11/07/2013 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00G446570 | (05) | CA |
A49713 | (02) |