Healthcare Provider Details

I. General information

NPI: 1093974644
Provider Name (Legal Business Name): THEODORE JEEN SUNG M.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: TED SUNG M.D.

II. Dates (important events)

Enumeration Date: 06/07/2008
Last Update Date: 12/21/2021
Certification Date: 12/21/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

IV. Provider business mailing address

9333 IMPERIAL HWY
DOWNEY CA
90242-2812
US

V. Phone/Fax

Practice location:
  • Phone: 800-823-4040
  • Fax:
Mailing address:
  • Phone: 800-823-4040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number250543
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberMD0070212
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License NumberA115385
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: