Provider Demographics
NPI:1023079365
Name:SUNG, RAYMOND Y (MD)
Entity type:Individual
Prefix:DR
First Name:RAYMOND
Middle Name:Y
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:PO BOX 462750
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92046-2750
Mailing Address - Country:US
Mailing Address - Phone:760-520-8500
Mailing Address - Fax:760-520-8523
Practice Address - Street 1:488 E VALLEY PKWY
Practice Address - Street 2:SUITE 100
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-3363
Practice Address - Country:US
Practice Address - Phone:760-739-5400
Practice Address - Fax:760-739-8471
Is Sole Proprietor?:No
Enumeration Date:2006-03-28
Last Update Date:2008-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA639652085R0202X, 2085R0204X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic Radiology
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional Radiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A639650Medicaid
CA00A639650Medicaid
CAWA63965KMedicare PIN
P00239718Medicare PIN
CAWA63965EMedicare PIN
CAWA63965FMedicare PIN
CAWA63965IMedicare PIN
CAWA63965DMedicare PIN
CAWA63965JMedicare PIN
CAWA63965CMedicare PIN
CAWA63965GMedicare PIN
CAWA63965HMedicare PIN