Provider Demographics
NPI:1912533134
Name:SUNG, ENG ANN (OD)
Entity Type:Individual
Prefix:
First Name:ENG ANN
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8225 GUPPY CT
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92129-3760
Mailing Address - Country:US
Mailing Address - Phone:858-527-5882
Mailing Address - Fax:
Practice Address - Street 1:8225 GUPPY CT
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92129-3760
Practice Address - Country:US
Practice Address - Phone:858-527-5882
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-19
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX10081152W00000X
390200000X
CA34533152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program