Healthcare Provider Details

I. General information

NPI: 1265859524
Provider Name (Legal Business Name): ANGELA SUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/25/2014
Last Update Date: 08/12/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10243 GENETIC CENTER DR
SAN DIEGO CA
92121
US

IV. Provider business mailing address

5651 COPLEY DR
SAN DIEGO CA
92111-7903
US

V. Phone/Fax

Practice location:
  • Phone: 858-526-6145
  • Fax: 858-526-6028
Mailing address:
  • Phone: 858-262-6344
  • Fax: 858-636-2032

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License NumberA155137
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: