Healthcare Provider Details

I. General information

NPI: 1790921963
Provider Name (Legal Business Name): JAMES R SISUNG II PSYD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/18/2008
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10535 HOSPITAL WAY
MATHER CA
95655-4200
US

IV. Provider business mailing address

1014 VANILLA BEAN LN
SACRAMENTO CA
95814-0981
US

V. Phone/Fax

Practice location:
  • Phone: 707-888-3179
  • Fax:
Mailing address:
  • Phone: 707-888-3179
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103G00000X
TaxonomyClinical Neuropsychologist
License NumberPS1271
License Number StateME

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: