Healthcare Provider Details

I. General information

NPI: 1053454520
Provider Name (Legal Business Name): ESTHER JUNGHAE SUNG M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 07/15/2022
Certification Date: 07/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4223 212TH ST
BAYSIDE NY
11361-2979
US

IV. Provider business mailing address

6702 230TH ST
BAYSIDE NY
11364-2751
US

V. Phone/Fax

Practice location:
  • Phone: 718-229-7337
  • Fax: 718-229-7333
Mailing address:
  • Phone: 201-270-7708
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number25MA07663400
License Number StateNJ
# 2
Primary TaxonomyN
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number219571
License Number StateMA
# 3
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number202465
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: