Provider Demographics
NPI:1649433129
Name:SUNG, WENJAY (DPM)
Entity type:Individual
Prefix:DR
First Name:WENJAY
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:DPM
Other - Prefix:
Other - First Name:JAY
Other - Middle Name:
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:301 W HUNTINGTON DR
Mailing Address - Street 2:SUITE 300
Mailing Address - City:ARCADIA
Mailing Address - State:CA
Mailing Address - Zip Code:91007-3462
Mailing Address - Country:US
Mailing Address - Phone:626-821-9323
Mailing Address - Fax:626-821-9325
Practice Address - Street 1:301 W HUNTINGTON DR
Practice Address - Street 2:SUITE 300
Practice Address - City:ARCADIA
Practice Address - State:CA
Practice Address - Zip Code:91007-3462
Practice Address - Country:US
Practice Address - Phone:626-821-9323
Practice Address - Fax:626-821-9325
Is Sole Proprietor?:No
Enumeration Date:2008-07-06
Last Update Date:2017-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL016-005436213ES0103X
PASC006009213ES0103X
CAE5032213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE5032OtherCA LICENSE
IL016-005436OtherPUBLIC AID ID#
IL517522003Medicare UPIN