Provider Demographics
NPI:1811562028
Name:SUNG, EUGENE (DC, PA-C)
Entity Type:Individual
Prefix:MR
First Name:EUGENE
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:DC, PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2100 CAMBRIDGE WAY
Mailing Address - Street 2:
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90503-7379
Mailing Address - Country:US
Mailing Address - Phone:310-227-1377
Mailing Address - Fax:
Practice Address - Street 1:24012 CALLE DE LA PLATA STE 120
Practice Address - Street 2:
Practice Address - City:LAGUNA HILLS
Practice Address - State:CA
Practice Address - Zip Code:92653-3632
Practice Address - Country:US
Practice Address - Phone:949-588-7246
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-30
Last Update Date:2022-04-05
Deactivation Date:2021-05-18
Deactivation Code:
Reactivation Date:2021-05-21
Provider Licenses
StateLicense IDTaxonomies
CA30886111N00000X
363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No111N00000XChiropractic ProvidersChiropractor