Provider Demographics
NPI:1033609656
Name:SUNG, JULIA (PA-C)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:JI HYE
Other - Middle Name:
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8906 SPANISH RIDGE AVE STE 202
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89148-1319
Mailing Address - Country:US
Mailing Address - Phone:702-330-3102
Mailing Address - Fax:702-912-4994
Practice Address - Street 1:517 ROSE ST
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89106-4020
Practice Address - Country:US
Practice Address - Phone:702-438-4692
Practice Address - Fax:702-485-2372
Is Sole Proprietor?:Yes
Enumeration Date:2018-05-18
Last Update Date:2020-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPA1996363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant