Provider Demographics
NPI:1023348836
Name:TUNG, TAN C (FNP)
Entity type:Individual
Prefix:
First Name:TAN
Middle Name:C
Last Name:TUNG
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:TAN
Other - Middle Name:C
Other - Last Name:SAETEURN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:FNP
Mailing Address - Street 1:3415 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95817-3648
Mailing Address - Country:US
Mailing Address - Phone:916-233-4910
Mailing Address - Fax:916-731-8149
Practice Address - Street 1:3415 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95817-3648
Practice Address - Country:US
Practice Address - Phone:916-233-4910
Practice Address - Fax:916-731-8149
Is Sole Proprietor?:No
Enumeration Date:2009-12-30
Last Update Date:2009-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA17910363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily