Provider Demographics
NPI:1336278720
Name:SUNG, KAY KEEYEUL (MD)
Entity Type:Individual
Prefix:DR
First Name:KAY
Middle Name:KEEYEUL
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 1:301 EDGEWATER TOWNE CTR
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-1298
Mailing Address - Country:US
Mailing Address - Phone:562-714-5849
Mailing Address - Fax:
Practice Address - Street 1:1525 SUPERIOR AVE STE 210
Practice Address - Street 2:
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92663-3656
Practice Address - Country:US
Practice Address - Phone:949-722-3555
Practice Address - Fax:949-722-3512
Is Sole Proprietor?:No
Enumeration Date:2007-03-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA86806207N00000X, 207ND0900X, 207ND0101X, 207NS0135X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered207N00000XAllopathic & Osteopathic PhysiciansDermatology
Not Answered207ND0900XAllopathic & Osteopathic PhysiciansDermatologyDermatopathology
Not Answered207ND0101XAllopathic & Osteopathic PhysiciansDermatologyMOHS-Micrographic Surgery
Not Answered207NS0135XAllopathic & Osteopathic PhysiciansDermatologyProcedural Dermatology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI12197Medicare UPIN
CAWA86806AMedicare ID - Type Unspecified