Provider Demographics
NPI:1275532996
Name:SUNG, CHARLES C (MD)
Entity Type:Individual
Prefix:DR
First Name:CHARLES
Middle Name:C
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 1:317 N DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-7750
Mailing Address - Country:US
Mailing Address - Phone:509-736-5550
Mailing Address - Fax:509-737-8281
Practice Address - Street 1:317 N DELAWARE ST
Practice Address - Street 2:
Practice Address - City:KENNEWICK
Practice Address - State:WA
Practice Address - Zip Code:99336-7750
Practice Address - Country:US
Practice Address - Phone:509-736-5550
Practice Address - Fax:509-737-8281
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-14
Last Update Date:2017-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD21609207W00000X
WAMD36139207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WAMD36139OtherMEDICAL LICENSE
WA1104926Medicaid
OR130346Medicaid
WA123380OtherLABOR AND INDUSTERIES
ORMD21609OtherMEDICAL LICENSE
WAAB04871Medicare ID - Type Unspecified
WAMD36139OtherMEDICAL LICENSE
WA180034762Medicare ID - Type UnspecifiedRAILROAD MEDICARE