Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 213E00000X | Podiatrist | E4670 | CA |
Y | 222Z00000X | Podiatrist | E4670 | CA |
NPI | 1013060847 |
---|---|
Provider Name | Steve M Tung |
First Address | Los Angeles, CA 90063 |
Second Address | Los Angeles, CA 90063-2326 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2007 |
Last Update Date | 11/06/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
E4670 | CA LICENSE (01) | CA |