Provider Demographics
NPI:1215038450
Name:KUNG, FEI TAN
Entity Type:Individual
Prefix:MR
First Name:FEI TAN
Middle Name:
Last Name:KUNG
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 1:10510 E GEYER WILLOW RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85747-9523
Mailing Address - Country:US
Mailing Address - Phone:520-574-0402
Mailing Address - Fax:
Practice Address - Street 1:10510 E GEYER WILLOW RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85747-9523
Practice Address - Country:US
Practice Address - Phone:520-574-0402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13390183500000X
MI5302031460183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist