Provider Demographics
NPI:1932145315
Name:SUNGA, VICTOR ISIP (MD)
Entity Type:Individual
Prefix:DR
First Name:VICTOR
Middle Name:ISIP
Last Name:SUNGA
Suffix:
Gender:M
Credentials:MD
Other - Prefix:DR
Other - First Name:VICTOR
Other - Middle Name:ISIP
Other - Last Name:SUNGA
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1101 N CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TULARE
Mailing Address - State:CA
Mailing Address - Zip Code:93274-2231
Mailing Address - Country:US
Mailing Address - Phone:559-685-4622
Mailing Address - Fax:559-686-2375
Practice Address - Street 1:1101 N CHERRY ST
Practice Address - Street 2:
Practice Address - City:TULARE
Practice Address - State:CA
Practice Address - Zip Code:93274-2231
Practice Address - Country:US
Practice Address - Phone:559-686-9097
Practice Address - Fax:559-686-4750
Is Sole Proprietor?:No
Enumeration Date:2006-06-22
Last Update Date:2012-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301080188207Q00000X
CAA91232207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
05362249OtherECFMG NUMBER
MI4775071Medicaid
MI4775071Medicaid
05362249OtherECFMG NUMBER