Provider Demographics
NPI:1275520892
Name:SANG, YOU SUNG (MD)
Entity Type:Individual
Prefix:
First Name:YOU SUNG
Middle Name:
Last Name:SANG
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 1:105 WAWECUS ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-2146
Mailing Address - Country:US
Mailing Address - Phone:860-859-9061
Mailing Address - Fax:860-889-6200
Practice Address - Street 1:105 WAWECUS ST
Practice Address - Street 2:SUITE 1
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-2146
Practice Address - Country:US
Practice Address - Phone:860-859-9061
Practice Address - Fax:860-889-6200
Is Sole Proprietor?:No
Enumeration Date:2005-09-29
Last Update Date:2014-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT034513207RG0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207RG0100XAllopathic & Osteopathic PhysiciansInternal MedicineGastroenterology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT2543591OtherAETNA HMO
CT345130OtherCONNECTICARE
CT5860483OtherAETNA PPO
CTNLS084OtherOXFORD HEALTH PLAN
CT010034513CT01OtherANTHEM BCBS OF CT
CT345130OtherCONNECTICARE
CTNLS084OtherOXFORD HEALTH PLAN
100000286Medicare ID - Type Unspecified