MEDICARE: ROBERTA KUNG MD INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207L00000X	Anesthesiology Physician

General Provider Information

NPI Number	:	1720020365
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA KUNG MD INC

Provider Business Mailing Address
First Line	:	150 BLUFF AVE
Second Line	:
City	:	NORTH AUGUSTA
State	:	SC
Zip	:	29841-3862
Country	:	US
Telephone Number	:	800-394-4445
Fax Number	:

Provider Business Practice Location Address
First Line	:	1821 MARCHEETA PL
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90069-1116
Country	:	US
Telephone Number	:	323-822-7406
Fax Number	:

Authorized Official
Title or Position	:	OWNER OF GROUP
Name	:	ROBERTA KUNG
Credential	:	MD
Telephone Number	:	323-822-7406

Provider Enumeration Date	:	06/11/2006
Last Update Date	:	01/07/2016

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