Provider Demographics
NPI:1114231198
Name:SUNG, DONGJIN (MD)
Entity Type:Individual
Prefix:DR
First Name:DONGJIN
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:LUKE
Other - Middle Name:
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1740 W GARDENA BLVD
Mailing Address - Street 2:
Mailing Address - City:GARDENA
Mailing Address - State:CA
Mailing Address - Zip Code:90247-4764
Mailing Address - Country:US
Mailing Address - Phone:716-868-9146
Mailing Address - Fax:
Practice Address - Street 1:1740 W GARDENA BLVD
Practice Address - Street 2:
Practice Address - City:GARDENA
Practice Address - State:CA
Practice Address - Zip Code:90247-4764
Practice Address - Country:US
Practice Address - Phone:424-551-3110
Practice Address - Fax:844-272-8062
Is Sole Proprietor?:No
Enumeration Date:2010-08-02
Last Update Date:2020-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2012013838207R00000X
MDD79453207R00000X
VA0101261199207R00000X
CAA155831207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine