Provider Demographics
NPI:1518941673
Name:KUNG, HENRY I-TSAI (MD)
Entity Type:Individual
Prefix:DR
First Name:HENRY
Middle Name:I-TSAI
Last Name:KUNG
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 1:120 LA CASA VIA, SUITE 107
Mailing Address - Street 2:
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-3092
Mailing Address - Country:US
Mailing Address - Phone:925-945-6070
Mailing Address - Fax:925-945-8767
Practice Address - Street 1:120 LA CASA VIA
Practice Address - Street 2:
Practice Address - City:WALNUT CREEK
Practice Address - State:CA
Practice Address - Zip Code:94598-3092
Practice Address - Country:US
Practice Address - Phone:925-945-6070
Practice Address - Fax:925-945-8767
Is Sole Proprietor?:Yes
Enumeration Date:2005-12-02
Last Update Date:2010-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG39076207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA47695Medicare UPIN