Provider Demographics
NPI:1922309095
Name:KUN, TINA J
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:J
Last Name:KUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TINA
Other - Middle Name:J
Other - Last Name:HANKUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:302 N GARFIELD AVE STE 1
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-1773
Mailing Address - Country:US
Mailing Address - Phone:626-280-2088
Mailing Address - Fax:626-280-8286
Practice Address - Street 1:302 N GARFIELD AVE STE 1
Practice Address - Street 2:
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-1773
Practice Address - Country:US
Practice Address - Phone:626-280-2088
Practice Address - Fax:626-280-8286
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-05
Last Update Date:2012-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAHA4197237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist