Provider Demographics
NPI:1942286349
Name:KUNG, SHIRLEY (MD)
Entity Type:Individual
Prefix:
First Name:SHIRLEY
Middle Name:
Last Name:KUNG
Suffix:
Gender:F
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:PO BOX 5788
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80217-5788
Mailing Address - Country:US
Mailing Address - Phone:303-202-1280
Mailing Address - Fax:303-202-1281
Practice Address - Street 1:11600 W 2ND PL
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80228-1527
Practice Address - Country:US
Practice Address - Phone:303-202-1280
Practice Address - Fax:303-202-1281
Is Sole Proprietor?:No
Enumeration Date:2005-12-16
Last Update Date:2015-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXL9298207P00000X
CO45656207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX168664401Medicaid
COP00464087OtherRAILROAD MEDICARE
TX168664402Medicaid
TX168664403Medicaid
CO75581710Medicaid
TXP00157178OtherRAILROAD MEDICARE PROV NO
TXP00205531OtherRAILROAD MEDICARE PROV NO
TX8G6287OtherBCBSTX PROV NO
TX168664403Medicaid
TX8C7623Medicare PIN
TX8C7624Medicare PIN
CO75581710Medicaid
TX168664402Medicaid