Provider Demographics
NPI:1972736486
Name:SUNG, AMY WAN-JUNG (LAC)
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:WAN-JUNG
Last Name:SUNG
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:WAN-JUNG
Other - Middle Name:
Other - Last Name:TSAI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:124 WARD ST
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:NY
Mailing Address - Zip Code:13601-4616
Mailing Address - Country:US
Mailing Address - Phone:626-679-2831
Mailing Address - Fax:
Practice Address - Street 1:124 WARD ST
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:NY
Practice Address - Zip Code:13601-4616
Practice Address - Country:US
Practice Address - Phone:626-679-2831
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-31
Last Update Date:2016-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAC13065171100000X
NY003834171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist