Provider Demographics
NPI:1992841068
Name:SUNG, MOON
Entity Type:Individual
Prefix:MRS
First Name:MOON
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 LA ROTONDA DR UNIT 107
Mailing Address - Street 2:
Mailing Address - City:RANCHO PALOS VERDES
Mailing Address - State:CA
Mailing Address - Zip Code:90275-6146
Mailing Address - Country:US
Mailing Address - Phone:310-265-0246
Mailing Address - Fax:310-265-0246
Practice Address - Street 1:1100 PACIFIC COAST HWY
Practice Address - Street 2:
Practice Address - City:HERMOSA BEACH
Practice Address - State:CA
Practice Address - Zip Code:90254-3921
Practice Address - Country:US
Practice Address - Phone:310-374-2435
Practice Address - Fax:310-374-9586
Is Sole Proprietor?:No
Enumeration Date:2007-01-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1300XPharmacy Service ProvidersPharmacistPsychiatric