Provider Demographics
NPI:1255526216
Name:SUNGHO JUN MD PC INC
Entity type:Organization
Organization Name:SUNGHO JUN MD PC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DOCTOR
Authorized Official - Prefix:
Authorized Official - First Name:SUNGHO
Authorized Official - Middle Name:
Authorized Official - Last Name:JUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:505-437-8828
Mailing Address - Street 1:2559 MEDICAL DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:505-437-8828
Mailing Address - Fax:505-437-4122
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:SUITE B
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-437-8828
Practice Address - Fax:505-437-4122
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-12
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM46-81207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty