Provider Demographics
NPI:1023096252
Name:TZUNG, SHIE-PON (MD PHD)
Entity type:Individual
Prefix:
First Name:SHIE-PON
Middle Name:
Last Name:TZUNG
Suffix:
Gender:M
Credentials:MD PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1135 116TH AVE NE
Mailing Address - Street 2:#560
Mailing Address - City:BELLEVUE
Mailing Address - State:WA
Mailing Address - Zip Code:98004
Mailing Address - Country:US
Mailing Address - Phone:425-454-4768
Mailing Address - Fax:425-462-8021
Practice Address - Street 1:1135 116TH AVE NE
Practice Address - Street 2:#560
Practice Address - City:BELLEVUE
Practice Address - State:WA
Practice Address - Zip Code:98004
Practice Address - Country:US
Practice Address - Phone:425-454-4768
Practice Address - Fax:425-462-8021
Is Sole Proprietor?:No
Enumeration Date:2006-01-06
Last Update Date:2023-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT99746207RG0100X
WA31810207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA145887OtherL & I
WA8218612Medicaid
WA145887OtherL & I
G48586Medicare UPIN