1578596938 NPI number — WILLIAM SIAO-PING TUNG M.D.

Table of content: WILLIAM SIAO-PING TUNG M.D. (NPI 1578596938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1578596938 NPI number — WILLIAM SIAO-PING TUNG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
TUNG
Provider First Name:
WILLIAM
Provider Middle Name:
SIAO-PING
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1578596938
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/16/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1802 BRAEBURN DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SALEM
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
24153-7357
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
540-776-2010
Provider Business Mailing Address Fax Number:
540-725-5016

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1802 BRAEBURN DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SALEM
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
24153-7357
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
540-776-2010
Provider Business Practice Location Address Fax Number:
540-725-5016
Provider Enumeration Date:
07/09/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 2086S0129X , with the licence number:  2009020458 , registered in the state of MO ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: MD430518 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 2086S0129X , with the licence number: 0101253975 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 179422001 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578596938 , issued by the state of ( MO ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578596938 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 639934 . This is a "BCBS" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".
  • Identifier: 1019962960001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 1578596938 , issued by the state of ( IL ) . This identifiers is of the category "MEDICAID".
  • Identifier: P00410365 . This is a "MEDICARE RAILROAD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 992182 . This is a "HEALTHLINK" identifier , issued by the state of ( MO ) . This identifiers is of the category "OTHER".




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