Healthcare Provider Details

I. General information

NPI: 1588242390
Provider Name (Legal Business Name): SEAN TOOKER PADUNGTIN MD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/01/2021
Last Update Date: 08/05/2026
Certification Date: 08/05/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

145 KIMEL PARK DR STE 120
WINSTON SALEM NC
27103-6983
US

IV. Provider business mailing address

145 KIMEL PARK DR STE 120
WINSTON SALEM NC
27103-6983
US

V. Phone/Fax

Practice location:
  • Phone: 336-768-3212
  • Fax:
Mailing address:
  • Phone: 336-768-3212
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number2025-01255
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: