Provider Demographics
NPI:1124045109
Name:SUNG, YOUNG S (RPH)
Entity Type:Individual
Prefix:MRS
First Name:YOUNG
Middle Name:S
Last Name:SUNG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7134 VAN NUYS BLVD
Mailing Address - Street 2:
Mailing Address - City:VAN NUYS
Mailing Address - State:CA
Mailing Address - Zip Code:91405-3005
Mailing Address - Country:US
Mailing Address - Phone:818-787-9339
Mailing Address - Fax:818-787-0189
Practice Address - Street 1:7134 VAN NUYS BLVD
Practice Address - Street 2:
Practice Address - City:VAN NUYS
Practice Address - State:CA
Practice Address - Zip Code:91405-3005
Practice Address - Country:US
Practice Address - Phone:818-787-9339
Practice Address - Fax:818-787-0189
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41916183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist