Provider Demographics
NPI:1205007325
Name:SUNG, JOHN
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4331 NESCONSET HWY
Mailing Address - Street 2:
Mailing Address - City:PORT JEFFERSION STATION
Mailing Address - State:NY
Mailing Address - Zip Code:11776
Mailing Address - Country:US
Mailing Address - Phone:631-642-3019
Mailing Address - Fax:
Practice Address - Street 1:4331 NESCONSET HWY
Practice Address - Street 2:
Practice Address - City:PORT JEFFERSION STATION
Practice Address - State:NY
Practice Address - Zip Code:11776
Practice Address - Country:US
Practice Address - Phone:631-642-3019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-17
Last Update Date:2008-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY044859183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist