MEDICARE: TENZIN KUNSANG

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	390200000X	Student in an Organized Health Care Education/Training Program		NM
2	207Q00000X	Family Medicine Physician	MD2021-0593	NM

General Provider Information

NPI Number	:	1922595263
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TENZIN KUNSANG

Provider Business Mailing Address
First Line	:	MSC 09-5040 FAMILY MEDICINE 1 UNIVERSITY OF NEW MEXICO
Second Line	:
City	:	ALBUQUERQUE
State	:	NM
Zip	:	87131-0001
Country	:	US
Telephone Number	:	505-272-6607
Fax Number	:	505-272-8045

Provider Business Practice Location Address
First Line	:	5501 HERRERA DR
Second Line	:
City	:	SANTA FE
State	:	NM
Zip	:	87507-2684
Country	:	US
Telephone Number	:	505-913-3233
Fax Number	:	505-913-3224

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/20/2018
Last Update Date	:	09/21/2021

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