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General NPI Number Information
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NPI Number | 1508758558
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Entity Type | Individual
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Provider Name | JASON MALE (M) TUNG
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Gender | Male
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Dates
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Enumeration Date | 07/16/2025
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Last Update Date | 07/16/2025
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Provider Practice Location Address
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Address Line | 420 UNIVERSITY BLVD
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City | INDIANAPOLIS
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State | IN
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Zip | 46202-5147
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Country | US
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Telephone | 317-274-5555
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Fax |
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Provider Business Mailing Address
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Address Line | 1202 ELLISTON CT
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City | CROWN POINT
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State | IN
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Zip | 46307-2670
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Country | US
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Telephone | 219-669-7609
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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