Provider Demographics
NPI:1780711465
Name:YIN, SUSAN SUNA JUNG (DO)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:SUNA JUNG
Last Name:YIN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6985 S MAGIC CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85298-4183
Mailing Address - Country:US
Mailing Address - Phone:419-343-1155
Mailing Address - Fax:
Practice Address - Street 1:3336 E CHANDLER HEIGHTS RD
Practice Address - Street 2:BUILDING 6 SUITE 132
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85298-4259
Practice Address - Country:US
Practice Address - Phone:480-460-4949
Practice Address - Fax:480-460-5858
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-28
Last Update Date:2008-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ4716208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics