Provider Demographics
NPI:1992963292
Name:RONALD TUNG MD INC
Entity type:Organization
Organization Name:RONALD TUNG MD INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RONALD
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:818-993-6996
Mailing Address - Street 1:18433 ROSCOE BLVD STE 107
Mailing Address - Street 2:
Mailing Address - City:NORTHRIDGE
Mailing Address - State:CA
Mailing Address - Zip Code:91325-4130
Mailing Address - Country:US
Mailing Address - Phone:818-993-6996
Mailing Address - Fax:
Practice Address - Street 1:18433 ROSCOE BLVD
Practice Address - Street 2:SUITE 214
Practice Address - City:NORTHRIDGE
Practice Address - State:CA
Practice Address - Zip Code:91325-4108
Practice Address - Country:US
Practice Address - Phone:818-993-6996
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-23
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG44657261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG44657Medicaid
A49713Medicare UPIN