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General NPI Number Information
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NPI Number | 1780711465
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Entity Type | Individual
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Provider Name | SUSAN SUNA JUNG YIN D.O.
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Gender | Female
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Dates
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Enumeration Date | 02/28/2007
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Last Update Date | 08/21/2008
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Provider Practice Location Address
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Address Line | 3336 E CHANDLER HEIGHTS RD BUILDING 6 SUITE 132
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City | GILBERT
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State | AZ
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Zip | 85298-4259
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Country | US
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Telephone | 480-460-4949
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Fax | 480-460-5858
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Provider Business Mailing Address
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Address Line | 6985 S MAGIC CT
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City | GILBERT
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State | AZ
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Zip | 85298-4183
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Country | US
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Telephone | 419-343-1155
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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 | 208000000X
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Taxonomy Name | Pediatrics Physician
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License Number | 4716
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License Number State | AZ
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