Provider Demographics
NPI:1508758558
Name:TUNG, JASON MALE (M)
Entity type:Individual
Prefix:
First Name:JASON
Middle Name:MALE (M)
Last Name:TUNG
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 1:1202 ELLISTON CT
Mailing Address - Street 2:
Mailing Address - City:CROWN POINT
Mailing Address - State:IN
Mailing Address - Zip Code:46307-2670
Mailing Address - Country:US
Mailing Address - Phone:219-669-7609
Mailing Address - Fax:
Practice Address - Street 1:420 UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46202-5147
Practice Address - Country:US
Practice Address - Phone:317-274-5555
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-07-16
Last Update Date:2025-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program