Provider Demographics
NPI:1154049450
Name:TEM, STALONE WUNG
Entity type:Individual
Prefix:
First Name:STALONE
Middle Name:WUNG
Last Name:TEM
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11505 DUCKETTOWN RD
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-9708
Mailing Address - Country:US
Mailing Address - Phone:505-557-7764
Mailing Address - Fax:
Practice Address - Street 1:11505 DUCKETTOWN RD
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-9708
Practice Address - Country:US
Practice Address - Phone:505-557-7764
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-22
Last Update Date:2022-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC70344063Medicaid
DC000000001Medicaid