Provider Demographics
NPI:1053706705
Name:KUNG, SHU TING (MD)
Entity type:Individual
Prefix:DR
First Name:SHU TING
Middle Name:
Last Name:KUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:CHARLIE
Other - Middle Name:
Other - Last Name:KUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:107 N. GREENFIELD ROAD
Mailing Address - Street 2:SUITE 1
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85205
Mailing Address - Country:US
Mailing Address - Phone:480-741-8041
Mailing Address - Fax:480-741-8045
Practice Address - Street 1:107 N. GREENFIELD ROAD
Practice Address - Street 2:SUITE 1
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85205
Practice Address - Country:US
Practice Address - Phone:480-741-8041
Practice Address - Fax:480-741-8045
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-31
Last Update Date:2024-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ52756207R00000X, 208M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208M00000XAllopathic & Osteopathic PhysiciansHospitalist
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine