Provider Demographics
NPI:1164545133
Name:SUNG, SIMON (NMD)
Entity Type:Individual
Prefix:DR
First Name:SIMON
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:560 W BROWN RD STE 2007
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85201-3224
Mailing Address - Country:US
Mailing Address - Phone:480-461-1255
Mailing Address - Fax:480-461-1262
Practice Address - Street 1:560 W BROWN RD STE 2007
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85201-3224
Practice Address - Country:US
Practice Address - Phone:480-461-1255
Practice Address - Fax:480-461-1262
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ05-849175F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175F00000XOther Service ProvidersNaturopath