Provider Demographics
NPI:1982781183
Name:UNG, ALVIN W (DPM)
Entity Type:Individual
Prefix:
First Name:ALVIN
Middle Name:W
Last Name:UNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1601 W BEVERLY BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTEBELLO
Mailing Address - State:CA
Mailing Address - Zip Code:90640-3931
Mailing Address - Country:US
Mailing Address - Phone:323-721-6026
Mailing Address - Fax:323-887-1891
Practice Address - Street 1:1601 W BEVERLY BLVD
Practice Address - Street 2:
Practice Address - City:MONTEBELLO
Practice Address - State:CA
Practice Address - Zip Code:90640-3931
Practice Address - Country:US
Practice Address - Phone:323-721-6026
Practice Address - Fax:323-887-1891
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAE3593213ES0131X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0131XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW12208AMedicare ID - Type Unspecified
CAT95746Medicare UPIN