Provider Demographics
NPI:1235466327
Name:SUN C SOUNG,M.D.,INC
Entity Type:Organization
Organization Name:SUN C SOUNG,M.D.,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SUN
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOUNG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-875-3595
Mailing Address - Street 1:1734 N RIVERSIDE AVE
Mailing Address - Street 2:SUITE 2
Mailing Address - City:RIALTO
Mailing Address - State:CA
Mailing Address - Zip Code:92376-8058
Mailing Address - Country:US
Mailing Address - Phone:909-875-3595
Mailing Address - Fax:909-875-1029
Practice Address - Street 1:1734 N RIVERSIDE AVE
Practice Address - Street 2:SUITE 2
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-8058
Practice Address - Country:US
Practice Address - Phone:909-875-3595
Practice Address - Fax:909-875-1029
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA34265261QP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A342650Medicaid
CA00A342650Medicare PIN
CAA88094Medicare UPIN