Provider Demographics
NPI:1205865573
Name:SUNG, JUNG H (PA-C)
Entity Type:Individual
Prefix:
First Name:JUNG
Middle Name:H
Last Name:SUNG
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25751 MCBEAN PKWY
Mailing Address - Street 2:SUITE 305
Mailing Address - City:VALENCIA
Mailing Address - State:CA
Mailing Address - Zip Code:91355-3701
Mailing Address - Country:US
Mailing Address - Phone:661-799-2542
Mailing Address - Fax:661-253-0248
Practice Address - Street 1:25751 MCBEAN PKWY
Practice Address - Street 2:SUITE 305
Practice Address - City:VALENCIA
Practice Address - State:CA
Practice Address - Zip Code:91355-3701
Practice Address - Country:US
Practice Address - Phone:661-799-2542
Practice Address - Fax:661-253-0248
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMA052539363A00000X
CAPA20095363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical