Healthcare Provider Details

I. General information

NPI: 1932537586
Provider Name (Legal Business Name): SUNG YUP JUNG
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/17/2013
Last Update Date: 10/06/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 LILIHA ST SUITE 601
HONOLULU HI
96817-3562
US

IV. Provider business mailing address

1520 LILIHA ST SUITE 601
HONOLULU HI
96817-3562
US

V. Phone/Fax

Practice location:
  • Phone: 808-523-0445
  • Fax: 808-523-0442
Mailing address:
  • Phone: 808-523-0445
  • Fax: 808-523-0442

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number1629
License Number StateHI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: