Provider Demographics
NPI:1477511475
Name:OR, SUNG KWONG (DO)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:KWONG
Last Name:OR
Suffix:
Gender:M
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 MARSETTA DR
Mailing Address - Street 2:
Mailing Address - City:BEAVERCREEK
Mailing Address - State:OH
Mailing Address - Zip Code:45432-2733
Mailing Address - Country:US
Mailing Address - Phone:937-427-2828
Mailing Address - Fax:937-427-2880
Practice Address - Street 1:1538 MARSETTA DR
Practice Address - Street 2:
Practice Address - City:BEAVERCREEK
Practice Address - State:OH
Practice Address - Zip Code:45432-2733
Practice Address - Country:US
Practice Address - Phone:937-427-2828
Practice Address - Fax:937-427-2880
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-02
Last Update Date:2022-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34008241O207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000384230OtherANTHEM
OH510552661027OtherCARE SOURCE
OH2492324Medicaid
OHI09211Medicare UPIN
OH4136306Medicare ID - Type Unspecified