Provider Demographics
NPI:1528019304
Name:SUNG, JEFF D (MD)
Entity Type:Individual
Prefix:
First Name:JEFF
Middle Name:D
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:4401 W MEMORIAL RD
Mailing Address - Street 2:SUITE 121
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73134-1785
Mailing Address - Country:US
Mailing Address - Phone:405-751-4664
Mailing Address - Fax:405-749-4561
Practice Address - Street 1:2021 SANTA MONICA BLVD STE 245E
Practice Address - Street 2:
Practice Address - City:SANTA MONICA
Practice Address - State:CA
Practice Address - Zip Code:90404-2132
Practice Address - Country:US
Practice Address - Phone:310-829-8975
Practice Address - Fax:424-291-4108
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2024-01-25
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Provider Licenses
StateLicense IDTaxonomies
CAA75061207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A750610Medicaid
CA00A750610Medicaid
H85861Medicare UPIN