Healthcare Provider Details

I. General information

NPI: 1750770905
Provider Name (Legal Business Name): MUJALIN THUNTARUG PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2015
Last Update Date: 01/12/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14212 AMBAUM BLVD SW SUITE 106
BURIEN WA
98166-1449
US

IV. Provider business mailing address

14212 AMBAUM BLVD SW SUITE 106
BURIEN WA
98166-1449
US

V. Phone/Fax

Practice location:
  • Phone: 206-244-5520
  • Fax: 206-957-0034
Mailing address:
  • Phone: 206-244-5520
  • Fax: 206-957-0034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA.60512148
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: