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General NPI Number Information
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NPI Number | 1235594185
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Entity Type | Individual
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Provider Name | EUNJAE SUNG CRNP
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Gender | Female
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Dates
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Enumeration Date | 12/18/2015
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Last Update Date | 09/17/2024
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Provider Practice Location Address
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Address Line | 1740 W GARDENA BLVD
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City | GARDENA
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State | CA
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Zip | 90247-4764
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Country | US
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Telephone | 164-804-3637
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Fax |
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Provider Business Mailing Address
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Address Line | 1740 W GARDENA BLVD
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City | GARDENA
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State | CA
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Zip | 90247-4764
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Country | US
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Telephone | 716-480-4363
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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 | 208M00000X
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Taxonomy Name | Hospitalist Physician
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License Number | 0024174203
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | R218810
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 363LP2300X
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Taxonomy Name | Primary Care Nurse Practitioner
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License Number | 95010489
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License Number State | CA
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