Healthcare Provider Details

I. General information

NPI: 1053706705
Provider Name (Legal Business Name): SHU TING KUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

Provider Other Name: CHARLIE KUNG MD

II. Dates (important events)

Enumeration Date: 03/31/2015
Last Update Date: 08/06/2026
Certification Date: 08/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

107 N. GREENFIELD ROAD SUITE 1
MESA AZ
85205
US

IV. Provider business mailing address

107 N GREENFIELD RD STE 1
MESA AZ
85205-7802
US

V. Phone/Fax

Practice location:
  • Phone: 480-741-8041
  • Fax: 480-741-8045
Mailing address:
  • Phone: 480-741-8041
  • Fax: 480-741-8045

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208M00000X
TaxonomyHospitalist Physician
License Number52756
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License Number52756
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: