Provider Demographics
NPI:1396962353
Name:TAN, RUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:RUNG
Middle Name:
Last Name:TAN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13175 PARAMOUNT BLVD
Mailing Address - Street 2:
Mailing Address - City:SOUTH GATE
Mailing Address - State:CA
Mailing Address - Zip Code:90280-7955
Mailing Address - Country:US
Mailing Address - Phone:562-633-9137
Mailing Address - Fax:562-633-9185
Practice Address - Street 1:13175 PARAMOUNT BLVD
Practice Address - Street 2:
Practice Address - City:SOUTH GATE
Practice Address - State:CA
Practice Address - Zip Code:90280-7955
Practice Address - Country:US
Practice Address - Phone:562-633-9137
Practice Address - Fax:562-633-9185
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33044122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist