Provider Demographics
NPI:1568562114
Name:BANG, SUCK JUN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUCK JUN
Middle Name:
Last Name:BANG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:15247 11TH ST
Mailing Address - Street 2:#1000
Mailing Address - City:VICTORVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:92395-3727
Mailing Address - Country:US
Mailing Address - Phone:760-245-0102
Mailing Address - Fax:760-245-6171
Practice Address - Street 1:15247 11TH ST
Practice Address - Street 2:#1000
Practice Address - City:VICTORVILLE
Practice Address - State:CA
Practice Address - Zip Code:92395-3727
Practice Address - Country:US
Practice Address - Phone:760-245-0102
Practice Address - Fax:760-245-6171
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-24
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA00A2454102080A0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2080A0000XAllopathic & Osteopathic PhysiciansPediatricsAdolescent Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A245410Medicaid
CA00A245410Medicaid