Provider Demographics
NPI:1689948168
Name:KUNG, CHIENWEI (PA-C)
Entity Type:Individual
Prefix:MR
First Name:CHIENWEI
Middle Name:
Last Name:KUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5931 STANLEY AVE
Mailing Address - Street 2:STE 8
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3846
Mailing Address - Country:US
Mailing Address - Phone:916-481-4389
Mailing Address - Fax:916-481-4307
Practice Address - Street 1:5931 STANLEY AVE STE 8
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3846
Practice Address - Country:US
Practice Address - Phone:916-481-4389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-01
Last Update Date:2016-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA976657133V00000X
CAPA22079363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered