Provider Demographics
NPI:1013264969
Name:SUNG, JAYUN
Entity Type:Individual
Prefix:
First Name:JAYUN
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 1:1401 S BROOKHURST RD STE 101
Mailing Address - Street 2:
Mailing Address - City:FULLERTON
Mailing Address - State:CA
Mailing Address - Zip Code:92833-4492
Mailing Address - Country:US
Mailing Address - Phone:714-992-4908
Mailing Address - Fax:714-992-2554
Practice Address - Street 1:1401 S BROOKHURST RD STE 101
Practice Address - Street 2:
Practice Address - City:FULLERTON
Practice Address - State:CA
Practice Address - Zip Code:92833-4492
Practice Address - Country:US
Practice Address - Phone:714-992-4908
Practice Address - Fax:714-992-2554
Is Sole Proprietor?:No
Enumeration Date:2012-08-10
Last Update Date:2016-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS0193331183500000X
CA68903183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist