Provider Demographics
NPI:1831348259
Name:SUNG, JIMMY C (MD)
Entity type:Individual
Prefix:DR
First Name:JIMMY
Middle Name:C
Last Name:SUNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1204 FOOTHILL WAY
Mailing Address - Street 2:
Mailing Address - City:MOUNTAINSIDE
Mailing Address - State:NJ
Mailing Address - Zip Code:07092-2043
Mailing Address - Country:US
Mailing Address - Phone:212-452-2800
Mailing Address - Fax:888-819-4578
Practice Address - Street 1:65 BROADWAY
Practice Address - Street 2:SUITE 1701
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10006-2503
Practice Address - Country:US
Practice Address - Phone:212-452-2800
Practice Address - Fax:888-819-4578
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-09
Last Update Date:2015-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD433499208200000X
NY252902-12086S0122X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2086S0122XAllopathic & Osteopathic PhysiciansSurgeryPlastic and Reconstructive Surgery
No208200000XAllopathic & Osteopathic PhysiciansPlastic Surgery