Provider Demographics
NPI:1477552917
Name:TAYLOR, SUNG IL (DO)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:IL
Last Name:TAYLOR
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 1:1800 W HIBISCUS BLVD STE 101
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:FL
Mailing Address - Zip Code:32901-2624
Mailing Address - Country:US
Mailing Address - Phone:321-726-1600
Mailing Address - Fax:321-726-1610
Practice Address - Street 1:1800 W HIBISCUS BLVD STE 101
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:FL
Practice Address - Zip Code:32901-2624
Practice Address - Country:US
Practice Address - Phone:321-726-1600
Practice Address - Fax:321-726-1610
Is Sole Proprietor?:No
Enumeration Date:2005-07-18
Last Update Date:2011-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007174-T207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2234942Medicaid
OH2234942Medicaid