Provider Demographics
NPI:1023039997
Name:MILLIE Y. TUNG, M.D.
Entity Type:Organization
Organization Name:MILLIE Y. TUNG, M.D.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MILLIE
Authorized Official - Middle Name:Y
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:425-453-8406
Mailing Address - Street 1:PO BOX 13684
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98198-1010
Mailing Address - Country:US
Mailing Address - Phone:206-592-5000
Mailing Address - Fax:206-824-9510
Practice Address - Street 1:2015 116TH AVE NE
Practice Address - Street 2:SUITE B
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004-3031
Practice Address - Country:US
Practice Address - Phone:425-453-8406
Practice Address - Fax:425-453-4173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-23
Last Update Date:2007-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1520501Medicaid
WA1520501Medicaid