Provider Demographics
NPI:1235194127
Name:SUNG, KWOK (MD)
Entity Type:Individual
Prefix:
First Name:KWOK
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2324 W PIERCE ST
Mailing Address - Street 2:
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220
Mailing Address - Country:US
Mailing Address - Phone:575-628-5051
Mailing Address - Fax:575-628-0493
Practice Address - Street 1:2420 W. PIERCE ST
Practice Address - Street 2:SUITE 104
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-5117
Practice Address - Country:US
Practice Address - Phone:575-885-0805
Practice Address - Fax:575-885-0793
Is Sole Proprietor?:No
Enumeration Date:2006-04-20
Last Update Date:2014-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2002-0383208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2237334Medicaid
NM00NM009D17OtherBCBS
NM00NM009D17OtherBCBS
NMB48396Medicare UPIN