Provider Demographics
NPI:1558611566
Name:SUNG, WONSIK (DC)
Entity Type:Individual
Prefix:DR
First Name:WONSIK
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11734 ARTESIA BLVD
Mailing Address - Street 2:
Mailing Address - City:ARTESIA
Mailing Address - State:CA
Mailing Address - Zip Code:90701-3804
Mailing Address - Country:US
Mailing Address - Phone:562-809-8669
Mailing Address - Fax:562-809-8122
Practice Address - Street 1:11734 ARTESIA BLVD
Practice Address - Street 2:
Practice Address - City:ARTESIA
Practice Address - State:CA
Practice Address - Zip Code:90701-3804
Practice Address - Country:US
Practice Address - Phone:562-809-8669
Practice Address - Fax:562-809-8122
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-17
Last Update Date:2012-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA21138111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes111N00000XChiropractic ProvidersChiropractor