Provider Demographics
NPI:1922016435
Name:SUM, LAI YUNG (NP)
Entity Type:Individual
Prefix:MS
First Name:LAI
Middle Name:YUNG
Last Name:SUM
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:450 N END AVE
Mailing Address - Street 2:APT. 5C
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10282-1105
Mailing Address - Country:US
Mailing Address - Phone:212-619-4112
Mailing Address - Fax:
Practice Address - Street 1:450 N END AVE
Practice Address - Street 2:APT. 5C
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10282-1105
Practice Address - Country:US
Practice Address - Phone:212-619-4112
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-08-03
Last Update Date:2015-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY340294363L00000X
NY302741363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02040499Medicaid
90N901Medicare ID - Type Unspecified
S82886Medicare UPIN