Healthcare Provider Details

I. General information

NPI: 1811562028
Provider Name (Legal Business Name): EUGENE SUNG DC, PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/30/2010
Last Update Date: 09/22/2026
Certification Date: 09/22/2026
Deactivation Date: 05/18/2021
Reactivation Date: 05/21/2021

III. Provider practice location address

2001 SANTA MONICA BLVD STE 560W
SANTA MONICA CA
90404-2182
US

IV. Provider business mailing address

2001 SANTA MONICA BLVD STE 560W
SANTA MONICA CA
90404-2182
US

V. Phone/Fax

Practice location:
  • Phone: 310-453-5654
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code111N00000X
TaxonomyChiropractor
License Number30886
License Number StateCA
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA59264
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: