Healthcare Provider Details

I. General information

NPI: 1780711465
Provider Name (Legal Business Name): SUSAN SUNA JUNG YIN D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/28/2007
Last Update Date: 08/21/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3336 E CHANDLER HEIGHTS RD BUILDING 6 SUITE 132
GILBERT AZ
85298-4259
US

IV. Provider business mailing address

6985 S MAGIC CT
GILBERT AZ
85298-4183
US

V. Phone/Fax

Practice location:
  • Phone: 480-460-4949
  • Fax: 480-460-5858
Mailing address:
  • Phone: 419-343-1155
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number4716
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: