Provider Demographics
NPI:1922595263
Name:KUNSANG, TENZIN
Entity Type:Individual
Prefix:
First Name:TENZIN
Middle Name:
Last Name:KUNSANG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:MSC 09-5040 FAMILY MEDICINE 1 UNIVERSITY OF NEW MEXICO
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87131-0001
Mailing Address - Country:US
Mailing Address - Phone:505-272-6607
Mailing Address - Fax:505-272-8045
Practice Address - Street 1:5501 HERRERA DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87507-2684
Practice Address - Country:US
Practice Address - Phone:505-913-3233
Practice Address - Fax:505-913-3224
Is Sole Proprietor?:Yes
Enumeration Date:2018-04-20
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM390200000X
NMMD2021-0593207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program