Georgia L Pung, M.D.

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

G062572 Issued in CA

Practice address

61 Camino Alto
Ste 108
Mill Valley, CA 94941-2934

Phone

(415) 388-6303

Fax

(415) 388-7136

NPI assigned

Jul 1, 2011

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Medicine

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309478400000",
    "number": "1003103714",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "910 ALTURAS WAY",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949414140",
            "telephone_number": "415-383-5904"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "61 CAMINO ALTO",
            "address_2": "STE 108",
            "city": "MILL VALLEY",
            "state": "CA",
            "postal_code": "949412934",
            "telephone_number": "415-388-6303",
            "fax_number": "415-388-7136"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PUNG",
        "first_name": "GEORGIA",
        "middle_name": "L",
        "name_prefix": "Dr.",
        "credential": "M.D.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2011-07-01",
        "last_updated": "2011-07-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "CA",
            "license": "G062572",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Jesus Antonio Prado
• Prima Medical Foundation
• James Pritchett
• Catherine Provencal
• Pulmonary & Critical Care Medicine, Inc.
• Quantum Physical Therapy
• Heidi Freya Queen, M.D
• Samuel Quinby, DPT
• Kira Quinn
• Theresa Raabe

• Pediatrics Physician in Mill Valley, CA
• Providers in Mill Valley, CA by specialty
• Pediatrics Physician in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 1, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.