Provider Demographics
NPI:1790929164
Name:HAM, SUNG WAN (MD)
Entity Type:Individual
Prefix:DR
First Name:SUNG
Middle Name:WAN
Last Name:HAM
Suffix:
Gender:M
Credentials:MD
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Mailing Address - Street 1:1050 PACIFIC COAST HWY FL 2
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-3509
Mailing Address - Country:US
Mailing Address - Phone:310-602-7927
Mailing Address - Fax:424-328-2634
Practice Address - Street 1:1050 PACIFIC COAST HWY FL 2
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-3509
Practice Address - Country:US
Practice Address - Phone:310-602-7927
Practice Address - Fax:424-328-2634
Is Sole Proprietor?:No
Enumeration Date:2009-04-28
Last Update Date:2023-05-22
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
CAA103684208600000X, 2086S0129X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0129XAllopathic & Osteopathic PhysiciansSurgeryVascular Surgery
No208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACC268XMedicare PIN