Basic Information
| Provider Information | |||||||||
| NPI: | 1578691754 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | TUNG | ||||||||
| FirstName: | VICTORIA | ||||||||
| MiddleName: | H | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | R.D., C.N.S.C., PA-C | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | TUNG | ||||||||
| OtherFirstName: | VICTORIA | ||||||||
| OtherMiddleName: | HUICHUNG WU | ||||||||
| OtherNamePrefix: | |||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 5 | ||||||||
| Mailing Information | |||||||||
| Address1: | 39350 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Practice Location | |||||||||
| Address1: | 39350 CIVIC CENTER DR | ||||||||
| Address2: | SUITE 300 | ||||||||
| City: | FREMONT | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945382343 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5107973933 | ||||||||
| FaxNumber: | 5107975184 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2007 | ||||||||
| LastUpdateDate: | 01/11/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| AuthorizedOfficialTelephone: | |||||||||
| IsSoleProprietor: | N | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 133V00000X | 836494 | CA | N | Dietary & Nutritional Service Providers | Dietitian, Registered | 363A00000X | 22893 | CA | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | PA22893 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
ID Information
| ID | Type | State | Issuer | Description | PA22893 | 01 | CA | CA LICENSE | OTHER |