Provider Demographics
NPI:1811931496
Name:SUNG, JOHN CHRISTOPHER (MD)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:CHRISTOPHER
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:204 CEDAR CREST AVE
Mailing Address - Street 2:APT. #4
Mailing Address - City:SOUTH PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91030-2036
Mailing Address - Country:US
Mailing Address - Phone:626-818-7881
Mailing Address - Fax:
Practice Address - Street 1:16237 VENTURA BLVD
Practice Address - Street 2:
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91436-2201
Practice Address - Country:US
Practice Address - Phone:818-995-5350
Practice Address - Fax:818-995-5032
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA64925207P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A649250Medicaid
CAH13559Medicare UPIN
CA00A649251Medicare PIN
CA00A649253Medicare PIN