Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207RG0100X | Gastroenterologist | 31810 | WA |
NPI | 1023096252 |
---|---|
Provider Name | Shie-Pon Tzung |
First Address | Bellevue, WA 98004 |
Second Address | Bellevue, WA 98004 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2006 |
Last Update Date | 08/07/2007 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
145887 | L & I (01) | WA |
8218612 | (05) | WA |
G48586 | (02) |