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General NPI Number Information
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NPI Number | 1568562114
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Entity Type | Individual
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Provider Name | SUCK JUN BANG M.D.
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Gender | Male
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Dates
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Enumeration Date | 09/24/2006
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 15247 11TH ST #1000
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City | VICTORVILLE
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State | CA
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Zip | 92395-3727
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Country | US
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Telephone | 760-245-0102
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Fax | 760-245-6171
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Provider Business Mailing Address
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Address Line | 15247 11TH ST #1000
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City | VICTORVILLE
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State | CA
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Zip | 92395-3727
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Country | US
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Telephone | 760-245-0102
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Fax | 760-245-6171
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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 | 2080A0000X
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Taxonomy Name | Pediatric Adolescent Medicine Physician
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License Number | 00A245410
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License Number State | CA
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