Provider Demographics
NPI:1578573572
Name:AUNG, TIN TUN (MD)
Entity Type:Individual
Prefix:DR
First Name:TIN
Middle Name:TUN
Last Name:AUNG
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 1:10800 MAGNOLIA AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92505-3043
Mailing Address - Country:US
Mailing Address - Phone:661-945-5984
Mailing Address - Fax:661-272-9107
Practice Address - Street 1:2260 E PALMDALE BLVD
Practice Address - Street 2:HERITAGE HEALTHCARE MEDICAL GROUP
Practice Address - City:PALMDALE
Practice Address - State:CA
Practice Address - Zip Code:93550-4952
Practice Address - Country:US
Practice Address - Phone:661-272-3777
Practice Address - Fax:661-272-9107
Is Sole Proprietor?:No
Enumeration Date:2006-08-09
Last Update Date:2021-11-29
Deactivation Date:2006-08-11
Deactivation Code:
Reactivation Date:2006-09-15
Provider Licenses
StateLicense IDTaxonomies
CAA76513207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A765130Medicaid
CA00A765130Medicaid
H66179Medicare UPIN