Provider Demographics
NPI:1982927810
Name:JUNG, SUNG KEW (RPH)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:KEW
Last Name:JUNG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6902 RIDGE BLVD APT A4
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN
Mailing Address - State:NY
Mailing Address - Zip Code:11209-1234
Mailing Address - Country:US
Mailing Address - Phone:718-748-9684
Mailing Address - Fax:
Practice Address - Street 1:15011 NORTHERN BLVD
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-3836
Practice Address - Country:US
Practice Address - Phone:718-358-3800
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-06
Last Update Date:2010-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY039185183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist