Provider Demographics
NPI:1255020095
Name:SUNG, ALEX KIWOOK (PT, DPT)
Entity type:Individual
Prefix:
First Name:ALEX
Middle Name:KIWOOK
Last Name:SUNG
Suffix:
Gender:M
Credentials:PT, DPT
Other - Prefix:DR
Other - First Name:ALEX
Other - Middle Name:KIWOOK
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:13311 KILKENNY CT UNIT 205
Mailing Address - Street 2:
Mailing Address - City:LA MIRADA
Mailing Address - State:CA
Mailing Address - Zip Code:90638-6296
Mailing Address - Country:US
Mailing Address - Phone:909-247-6339
Mailing Address - Fax:
Practice Address - Street 1:7755 CENTER AVE
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92647-3007
Practice Address - Country:US
Practice Address - Phone:714-372-2207
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-05-08
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT303748208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation