Healthcare Provider Details

I. General information

NPI: 1013646157
Provider Name (Legal Business Name): JEFF SUNG, MD A MEDICAL CORPORATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/06/2022
Last Update Date: 06/06/2022
Certification Date: 06/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15031 RINALDI ST
MISSION HILLS CA
91345-1207
US

IV. Provider business mailing address

2234 5TH ST
SANTA MONICA CA
90405-2402
US

V. Phone/Fax

Practice location:
  • Phone: 818-496-1837
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207PH0002X
TaxonomyHospice and Palliative Medicine (Emergency Medicine) Physician
License Number
License Number State

VIII. Authorized Official

Name: JEFF SUNG
Title or Position: OWNER
Credential:
Phone: 310-600-0938