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General NPI Number Information
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NPI Number | 1003082272
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Entity Type | Individual
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Provider Name | DR. CHRIS CHAN MOO SUNG
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Gender | Male
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Dates
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Enumeration Date | 05/07/2008
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Last Update Date | 11/20/2023
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Provider Practice Location Address
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Address Line | 790 CHURCH ST NE STE 400
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City | MARIETTA
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State | GA
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Zip | 30060-8957
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Country | US
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Telephone | 770-405-2976
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3157
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City | INDIANAPOLIS
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State | IN
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Zip | 46206-3157
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Country | US
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Telephone | 770-952-8899
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2085R0202X
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Taxonomy Name | Diagnostic Radiology Physician
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License Number | 87919
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License Number State | GA
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Taxonomy #2
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 242802
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 2085R0204X
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Taxonomy Name | Vascular & Interventional Radiology Physician
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License Number | 87919
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License Number State | GA
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