MEDICARE: SUSAN SUNA JUNG YIN D.O.

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	208000000X	Pediatrics Physician	4716	AZ

General Provider Information

NPI Number	:	1780711465
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUSAN SUNA JUNG YIN D.O.

Provider Business Mailing Address
First Line	:	6985 S MAGIC CT
Second Line	:
City	:	GILBERT
State	:	AZ
Zip	:	85298-4183
Country	:	US
Telephone Number	:	419-343-1155
Fax Number	:

Provider Business Practice Location Address
First Line	:	3336 E CHANDLER HEIGHTS RD
Second Line	:	BUILDING 6 SUITE 132
City	:	GILBERT
State	:	AZ
Zip	:	85298-4259
Country	:	US
Telephone Number	:	480-460-4949
Fax Number	:	480-460-5858

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

Provider Enumeration Date	:	02/28/2007
Last Update Date	:	08/21/2008

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