Provider Demographics
NPI:1336297282
Name:ZUNG, THOMAS (MD)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:
Last Name:ZUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1630 LA RAMADA AVE
Mailing Address - Street 2:
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91006-1822
Mailing Address - Country:US
Mailing Address - Phone:626-447-4477
Mailing Address - Fax:626-355-6962
Practice Address - Street 1:1630 LA RAMADA AVE
Practice Address - Street 2:
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91006-1822
Practice Address - Country:US
Practice Address - Phone:626-447-4477
Practice Address - Fax:626-355-6962
Is Sole Proprietor?:No
Enumeration Date:2007-01-08
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG412492085B0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085B0100XAllopathic & Osteopathic PhysiciansRadiologyBody Imaging
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G412490Medicaid
CAG41249Medicare UPIN
CA00G412490Medicaid