MEDICARE: DR. ADRIANNA SUNG DO

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician	UO5974	FL
2	207Q00000X	Family Medicine Physician	19130	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	OS16419	OTHER	FL	STATE LICENSE
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1548753411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ADRIANNA SUNG DO

Provider Business Mailing Address
First Line	:	1955 COWELL BLVD
Second Line	:
City	:	DAVIS
State	:	CA
Zip	:	95618-6325
Country	:	US
Telephone Number	:	530-757-7100
Fax Number	:

Provider Business Practice Location Address
First Line	:	775 W GRANADA BLVD
Second Line	:
City	:	ORMOND BEACH
State	:	FL
Zip	:	32174-5109
Country	:	US
Telephone Number	:	925-451-0138
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/14/2018
Last Update Date	:	01/17/2022

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Directions to “ DR. ADRIANNA SUNG DO” Practice Location

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