MEDICARE: DR. NISHA TUNG M.D.

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	207RC0000X	Cardiovascular Disease Physician	30696	AZ
2	207RC0001X	Clinical Cardiac Electrophysiology Physician	30696	AZ

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
3	060071200	OTHER	AZ	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	86080015085259A289	OTHER	AZ	TRIWEST

General Provider Information

NPI Number	:	1982688750
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. NISHA TUNG M.D.

Provider Business Mailing Address
First Line	:	PO BOX 10880
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86304-0880
Country	:	US
Telephone Number	:	602-406-4786
Fax Number	:	916-636-4358

Provider Business Practice Location Address
First Line	:	1001 WILLOW CREEK RD STE 2200
Second Line	:
City	:	PRESCOTT
State	:	AZ
Zip	:	86301-1614
Country	:	US
Telephone Number	:	928-445-6025
Fax Number	:	928-778-3026

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

Provider Enumeration Date	:	12/05/2005
Last Update Date	:	10/10/2025

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Directions to “ DR. NISHA TUNG M.D.” Practice Location

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