Provider Demographics
NPI:1669842332
Name:DIANE TUNG DDS PLLC
Entity Type:Organization
Organization Name:DIANE TUNG DDS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PEDIATRIC DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:206-853-7173
Mailing Address - Street 1:19270 AURORA AVE N
Mailing Address - Street 2:STE 2
Mailing Address - City:SHORELINE
Mailing Address - State:WA
Mailing Address - Zip Code:98133-3963
Mailing Address - Country:US
Mailing Address - Phone:206-853-7173
Mailing Address - Fax:
Practice Address - Street 1:128 NE 52ND ST
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98105-3752
Practice Address - Country:US
Practice Address - Phone:206-853-7173
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-06
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WADE60041548261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental