Provider Demographics
NPI:1912289612
Name:SUNG, HYE S
Entity Type:Individual
Prefix:
First Name:HYE
Middle Name:S
Last Name:SUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24930 WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:HARBOR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90710-2029
Mailing Address - Country:US
Mailing Address - Phone:310-891-1264
Mailing Address - Fax:310-891-1955
Practice Address - Street 1:24930 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:HARBOR CITY
Practice Address - State:CA
Practice Address - Zip Code:90710-2029
Practice Address - Country:US
Practice Address - Phone:310-891-1264
Practice Address - Fax:310-891-1955
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA60709183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA60709OtherBOARD OF PHARMACY