Healthcare Provider Details

I. General information

NPI: 1861048894
Provider Name (Legal Business Name): ELIZABETH SUNG FNP, RN, IBCLC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/15/2019
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 OREGON DR
SACRAMENTO CA
95822-2646
US

IV. Provider business mailing address

1621 OREGON DR
SACRAMENTO CA
95822-2646
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number95037837
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code163WL0100X
TaxonomyLactation Consultant (Registered Nurse)
License Number95037837
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number95182102
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: