Provider Demographics
NPI:1497768899
Name:TUNG, PRABHAS (MD)
Entity Type:Individual
Prefix:DR
First Name:PRABHAS
Middle Name:
Last Name:TUNG
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 1:2801 K ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-5120
Mailing Address - Country:US
Mailing Address - Phone:916-733-5003
Mailing Address - Fax:916-733-8290
Practice Address - Street 1:2801 K ST
Practice Address - Street 2:SUITE 200
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-5120
Practice Address - Country:US
Practice Address - Phone:916-733-5003
Practice Address - Fax:916-733-8290
Is Sole Proprietor?:No
Enumeration Date:2006-08-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA31185208200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA0031185Medicaid
A26382Medicare UPIN
CAA0031185Medicaid