Provider Demographics
NPI:1811437635
Name:KUNG, BERNARD DAVID
Entity type:Individual
Prefix:
First Name:BERNARD
Middle Name:DAVID
Last Name:KUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1351 W CAPITOL AVE
Mailing Address - Street 2:
Mailing Address - City:WEST SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95691-3213
Mailing Address - Country:US
Mailing Address - Phone:916-371-3801
Mailing Address - Fax:916-371-8401
Practice Address - Street 1:1351 W CAPITOL AVE
Practice Address - Street 2:
Practice Address - City:WEST SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95691-3213
Practice Address - Country:US
Practice Address - Phone:916-371-3801
Practice Address - Fax:916-371-8401
Is Sole Proprietor?:No
Enumeration Date:2017-02-27
Last Update Date:2017-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47671183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1093720377Medicaid