Provider Demographics
NPI:1942270749
Name:SUNG, KAP-JAE (MD)
Entity Type:Individual
Prefix:DR
First Name:KAP-JAE
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5645 MAIN ST
Mailing Address - Street 2:W-LL300
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11355-5045
Mailing Address - Country:US
Mailing Address - Phone:718-670-2127
Mailing Address - Fax:347-328-9362
Practice Address - Street 1:6683 70TH ST
Practice Address - Street 2:
Practice Address - City:MIDDLE VILLAGE
Practice Address - State:NY
Practice Address - Zip Code:11379-1739
Practice Address - Country:US
Practice Address - Phone:718-651-2929
Practice Address - Fax:718-651-3521
Is Sole Proprietor?:No
Enumeration Date:2006-01-24
Last Update Date:2014-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY161256208600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208600000XAllopathic & Osteopathic PhysiciansSurgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00956318Medicaid
NY03487616Medicaid
NY03487616Medicaid