Healthcare Provider Details

I. General information

NPI: 1316122104
Provider Name (Legal Business Name): SUNG IM MD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/31/2007
Last Update Date: 01/13/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 WILSHIRE BLVD
LOS ANGELES CA
90017-1901
US

IV. Provider business mailing address

3420 E TEMPLE WAY
WEST COVINA CA
91791-2329
US

V. Phone/Fax

Practice location:
  • Phone: 213-977-2121
  • Fax:
Mailing address:
  • Phone: 703-344-4855
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberA117206
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberA117206
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: