Provider Demographics
NPI:1952513590
Name:SHUNG, KENROY
Entity Type:Individual
Prefix:MR
First Name:KENROY
Middle Name:
Last Name:SHUNG
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 1:15116 PADDOCK CT
Mailing Address - Street 2:
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92394-7426
Mailing Address - Country:US
Mailing Address - Phone:760-951-5210
Mailing Address - Fax:
Practice Address - Street 1:15116 PADDOCK CT
Practice Address - Street 2:
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92394-7426
Practice Address - Country:US
Practice Address - Phone:760-951-5210
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-04
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator