Provider Demographics
NPI:1518606276
Name:TAMUKONG, PATRICK KHAN (MD, PHD)
Entity Type:Individual
Prefix:
First Name:PATRICK
Middle Name:KHAN
Last Name:TAMUKONG
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 S HAMEL RD APT 107
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90048-3816
Mailing Address - Country:US
Mailing Address - Phone:701-885-9193
Mailing Address - Fax:
Practice Address - Street 1:8635 W 3RD ST STE 1070W
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90048-6137
Practice Address - Country:US
Practice Address - Phone:310-423-4700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-06-01
Last Update Date:2022-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program