Healthcare Provider Details

I. General information

NPI: 1538100383
Provider Name (Legal Business Name): SUNG C RO MD
Entity Type: Individual
Gender: Male
Sole Proprietor: X

Provider Other Name: SUNG C RO MD

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3155 JOFFRE AVE
MEMPHIS TN
38111-3430
US

IV. Provider business mailing address

6751 TANGLEBERRY LN
MEMPHIS TN
38119-6716
US

V. Phone/Fax

Practice location:
  • Phone: 901-251-8086
  • Fax:
Mailing address:
  • Phone: 901-755-0606
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code173000000X
TaxonomyLegal Medicine
License Number0000010748
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: