Provider Demographics
NPI:1053317834
Name:SUNG-NAE BYUN M D MEDICAL GROUP INC
Entity Type:Organization
Organization Name:SUNG-NAE BYUN M D MEDICAL GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:NAE
Authorized Official - Last Name:BYUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:213-382-2700
Mailing Address - Street 1:2120 W 8TH ST
Mailing Address - Street 2:STE 102
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90057-4019
Mailing Address - Country:US
Mailing Address - Phone:213-382-2700
Mailing Address - Fax:213-382-5077
Practice Address - Street 1:2120 W 8TH ST
Practice Address - Street 2:STE 102
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90057-4019
Practice Address - Country:US
Practice Address - Phone:213-382-2700
Practice Address - Fax:213-382-5077
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-26
Last Update Date:2015-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA61249207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A612490Medicaid
CA00A612490Medicaid
CAW16820Medicare PIN