Healthcare Provider Details

I. General information

NPI: 1386589133
Provider Name (Legal Business Name): NEM SUNG
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/20/2026
Last Update Date: 04/20/2026
Certification Date: 04/20/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

19 E DAWES AVE STE A
BIXBY OK
74008-4414
US

IV. Provider business mailing address

7711 E 111TH ST STE 111
TULSA OK
74133-2563
US

V. Phone/Fax

Practice location:
  • Phone: 918-727-2928
  • Fax: 918-727-2928
Mailing address:
  • Phone: 918-727-2928
  • Fax: 918-727-2928

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106S00000X
TaxonomyBehavior Technician
License Number26-530048
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: