Provider Demographics
NPI:1043039019
Name:MERCY WOUND HEALING & MEDICAL SERVICES, LLC
Entity type:Organization
Organization Name:MERCY WOUND HEALING & MEDICAL SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PODIATRIST
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVE
Authorized Official - Middle Name:MINGKUANG
Authorized Official - Last Name:TUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DPM
Authorized Official - Phone:952-465-2830
Mailing Address - Street 1:2240 MAURICE AVE
Mailing Address - Street 2:
Mailing Address - City:LA CRESCENTA
Mailing Address - State:CA
Mailing Address - Zip Code:91214-1533
Mailing Address - Country:US
Mailing Address - Phone:952-465-2830
Mailing Address - Fax:
Practice Address - Street 1:2240 MAURICE AVE
Practice Address - Street 2:
Practice Address - City:LA CRESCENTA
Practice Address - State:CA
Practice Address - Zip Code:91214-1533
Practice Address - Country:US
Practice Address - Phone:952-465-2830
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-07
Last Update Date:2024-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatristGroup - Multi-Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty