Provider Demographics
NPI:1467982850
Name:TENGE, KUMAN
Entity Type:Individual
Prefix:
First Name:KUMAN
Middle Name:
Last Name:TENGE
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 1:10039 N ROXBURY DR
Mailing Address - Street 2:
Mailing Address - City:ORO VALLEY
Mailing Address - State:AZ
Mailing Address - Zip Code:85737-7958
Mailing Address - Country:US
Mailing Address - Phone:520-248-6393
Mailing Address - Fax:
Practice Address - Street 1:10039 N ROXBURY DR
Practice Address - Street 2:
Practice Address - City:ORO VALLEY
Practice Address - State:AZ
Practice Address - Zip Code:85737-7958
Practice Address - Country:US
Practice Address - Phone:520-248-6393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-18
Last Update Date:2020-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZBH6309385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZBH6309OtherAZ DEPT OF HEALTH SERVICES