Healthcare Provider Details

I. General information

NPI: 1194167841
Provider Name (Legal Business Name): SUNGWON OK N.P.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/23/2013
Last Update Date: 01/04/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10000 LAKEWOOD BLVD
DOWNEY CA
90240-4020
US

IV. Provider business mailing address

13602 CHARLEMAGNE AVE
BELLFLOWER CA
90706-2324
US

V. Phone/Fax

Practice location:
  • Phone: 562-862-3684
  • Fax:
Mailing address:
  • Phone: 808-218-8462
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP23201
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: