Healthcare Provider Details

I. General information

NPI: 1275361032
Provider Name (Legal Business Name): NORMAN KUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2024
Last Update Date: 08/03/2026
Certification Date: 08/03/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4856 VIA ALAMEDA
YORBA LINDA CA
92886-2902
US

IV. Provider business mailing address

4856 VIA ALAMEDA
YORBA LINDA CA
92886-2902
US

V. Phone/Fax

Practice location:
  • Phone: 714-261-3757
  • Fax:
Mailing address:
  • Phone: 714-261-3757
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number95144306
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: