Provider Demographics
NPI:1750770905
Name:THUNTARUG, MUJALIN (PA-C)
Entity type:Individual
Prefix:
First Name:MUJALIN
Middle Name:
Last Name:THUNTARUG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14212 AMBAUM BLVD SW
Mailing Address - Street 2:SUITE 106
Mailing Address - City:BURIEN
Mailing Address - State:WA
Mailing Address - Zip Code:98166-1449
Mailing Address - Country:US
Mailing Address - Phone:206-244-5520
Mailing Address - Fax:206-957-0034
Practice Address - Street 1:14212 AMBAUM BLVD SW
Practice Address - Street 2:SUITE 106
Practice Address - City:BURIEN
Practice Address - State:WA
Practice Address - Zip Code:98166-1449
Practice Address - Country:US
Practice Address - Phone:206-244-5520
Practice Address - Fax:206-957-0034
Is Sole Proprietor?:No
Enumeration Date:2015-01-12
Last Update Date:2015-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPA.60512148363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical