Provider Demographics
NPI:1134272891
Name:KUNG, GEORGE YUNG (MD)
Entity type:Individual
Prefix:DR
First Name:GEORGE
Middle Name:YUNG
Last Name:KUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13014 POLVERA AVE
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92128-1138
Mailing Address - Country:US
Mailing Address - Phone:858-485-7319
Mailing Address - Fax:
Practice Address - Street 1:120 CRAVEN RD
Practice Address - Street 2:STE 209
Practice Address - City:SAN MARCOS
Practice Address - State:CA
Practice Address - Zip Code:92078-4235
Practice Address - Country:US
Practice Address - Phone:760-761-4088
Practice Address - Fax:760-761-4090
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG40820207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G408290Medicaid
CAG40820Medicare ID - Type Unspecified
CA00G408290Medicaid