Provider Demographics
NPI:1457946964
Name:TUNG, PAWANVIR SINGH (PA-C)
Entity Type:Individual
Prefix:
First Name:PAWANVIR
Middle Name:SINGH
Last Name:TUNG
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5620 W THUNDERBIRD RD STE B3
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85306-4638
Mailing Address - Country:US
Mailing Address - Phone:602-206-6262
Mailing Address - Fax:602-235-0296
Practice Address - Street 1:5620 W THUNDERBIRD RD STE B3
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85306-4638
Practice Address - Country:US
Practice Address - Phone:602-206-6262
Practice Address - Fax:602-206-6262
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-05
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ8674363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant