Provider Demographics
NPI:1891095683
Name:IN SUNG SERVICE, INC.
Entity Type:Organization
Organization Name:IN SUNG SERVICE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BON JA
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-283-6166
Mailing Address - Street 1:1134 S WESTERN AVE
Mailing Address - Street 2:B2
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2366
Mailing Address - Country:US
Mailing Address - Phone:213-283-6166
Mailing Address - Fax:
Practice Address - Street 1:1134 S WESTERN AVE
Practice Address - Street 2:B2
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90006-2366
Practice Address - Country:US
Practice Address - Phone:213-283-6166
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X, 261QH0100X, 261QP2000X, 261QS1200X
CAAC 11329261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
No261QS1200XAmbulatory Health Care FacilitiesClinic/CenterSleep Disorder Diagnostic