Provider Demographics
NPI:1740943596
Name:SUNG, JIN SOOK (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JIN
Middle Name:SOOK
Last Name:SUNG
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3430 W WHEATLAND RD STE 202
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75237-3447
Mailing Address - Country:US
Mailing Address - Phone:972-283-1800
Mailing Address - Fax:972-283-1801
Practice Address - Street 1:3430 W WHEATLAND RD
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75237-3446
Practice Address - Country:US
Practice Address - Phone:972-780-5888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-10-19
Last Update Date:2021-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1055624363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily