Provider Demographics
NPI:1316038862
Name:SUNG, IK HYUN (MD)
Entity Type:Individual
Prefix:
First Name:IK
Middle Name:HYUN
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:PO BOX 7096
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95267-0096
Mailing Address - Country:US
Mailing Address - Phone:209-956-7725
Mailing Address - Fax:209-956-7733
Practice Address - Street 1:300 HOSPITAL DRIVE
Practice Address - Street 2:
Practice Address - City:VALLEJA
Practice Address - State:CA
Practice Address - Zip Code:94589-2574
Practice Address - Country:US
Practice Address - Phone:707-554-4444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2015-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA100231207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1316038862Medicaid
CABH907UMedicare PIN
CABH907YMedicare PIN
CABH907TMedicare PIN
CABH907VMedicare PIN
CABH907WMedicare PIN
CACA159009Medicare PIN
CABG694AMedicare PIN
CA1316038862Medicaid
CAP01532982Medicare PIN
CABH907XMedicare PIN