Provider Demographics
NPI:1932537586
Name:JUNG, SUNG YUP
Entity Type:Individual
Prefix:
First Name:SUNG YUP
Middle Name:
Last Name:JUNG
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 LILIHA ST
Mailing Address - Street 2:SUITE 601
Mailing Address - City:HONOLULU
Mailing Address - State:HI
Mailing Address - Zip Code:96817-3562
Mailing Address - Country:US
Mailing Address - Phone:808-523-0445
Mailing Address - Fax:808-523-0442
Practice Address - Street 1:1520 LILIHA ST
Practice Address - Street 2:SUITE 601
Practice Address - City:HONOLULU
Practice Address - State:HI
Practice Address - Zip Code:96817-3562
Practice Address - Country:US
Practice Address - Phone:808-523-0445
Practice Address - Fax:808-523-0442
Is Sole Proprietor?:No
Enumeration Date:2013-10-17
Last Update Date:2015-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI1629363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
HIH107181Medicare PIN