Provider Demographics
NPI:1043735343
Name:SUNTERPRISE HEALTH LLC
Entity Type:Organization
Organization Name:SUNTERPRISE HEALTH LLC
Other - Org Name:SKC DERMATOLOGY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNNY
Authorized Official - Middle Name:KYUNG
Authorized Official - Last Name:CHUN
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:917-558-0393
Mailing Address - Street 1:4 FOREST AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:PARAMUS
Mailing Address - State:NJ
Mailing Address - Zip Code:07652-5214
Mailing Address - Country:US
Mailing Address - Phone:917-558-0393
Mailing Address - Fax:
Practice Address - Street 1:4 FOREST AVE STE 205
Practice Address - Street 2:
Practice Address - City:PARAMUS
Practice Address - State:NJ
Practice Address - Zip Code:07652-5214
Practice Address - Country:US
Practice Address - Phone:201-879-0303
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-08
Last Update Date:2019-08-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ25MB09569900207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY1982986634Medicaid