Basic Information
| Provider Information | |||||||||
| NPI: | 1740634245 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SHUNG | ||||||||
| FirstName: | SERENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | MSC 09 5040 | ||||||||
| Address2: | 1 UNIVERSITY OF NEW MEXICO | ||||||||
| City: | ALBUQUERQUE | ||||||||
| State: | NM | ||||||||
| PostalCode: | 871310001 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5052726607 | ||||||||
| FaxNumber: | 5052728045 | ||||||||
| Practice Location | |||||||||
| Address1: | 3801 150TH AVE SE | ||||||||
| Address2: | |||||||||
| City: | BELLEVUE | ||||||||
| State: | WA | ||||||||
| PostalCode: | 980061668 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4254607140 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 04/20/2016 | ||||||||
| LastUpdateDate: | 12/07/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 12/07/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | MD60929348 | WA | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.