Healthcare Provider Details

I. General information

NPI: 1245358050
Provider Name (Legal Business Name): CHARLES SUNG MD PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/27/2007
Last Update Date: 11/08/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

317 N DELAWARE ST
KENNEWICK WA
99336-7750
US

IV. Provider business mailing address

317 N DELAWARE ST
KENNEWICK WA
99336-7750
US

V. Phone/Fax

Practice location:
  • Phone: 509-736-5550
  • Fax: 509-737-8281
Mailing address:
  • Phone: 509-736-5550
  • Fax: 509-737-8281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207W00000X
TaxonomyOphthalmology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. CHARLES C SUNG
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 509-736-5550