Provider Demographics
NPI:1083031769
Name:REICHERT, SUNEUN SARAH (DO)
Entity Type:Individual
Prefix:
First Name:SUNEUN
Middle Name:SARAH
Last Name:REICHERT
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:SUNEUN
Other - Middle Name:SARAH
Other - Last Name:KIM
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DO
Mailing Address - Street 1:14642 NEWPORT AVE STE 300
Mailing Address - Street 2:
Mailing Address - City:TUSTIN
Mailing Address - State:CA
Mailing Address - Zip Code:92780-6059
Mailing Address - Country:US
Mailing Address - Phone:714-247-0300
Mailing Address - Fax:714-259-1598
Practice Address - Street 1:1 HOPE DR
Practice Address - Street 2:
Practice Address - City:TUSTIN
Practice Address - State:CA
Practice Address - Zip Code:92782-0221
Practice Address - Country:US
Practice Address - Phone:714-247-0300
Practice Address - Fax:714-259-1598
Is Sole Proprietor?:Yes
Enumeration Date:2014-03-19
Last Update Date:2022-08-23
Deactivation Date:2019-04-15
Deactivation Code:
Reactivation Date:2019-04-24
Provider Licenses
StateLicense IDTaxonomies
171M00000X
CAPTL1271390200000X
CA19660207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program