MEDICARE: SUN C SOUNG,M.D.,INC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP2300X	Primary Care Clinic/Center	A34265	CA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1235466327
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SUN C SOUNG,M.D.,INC

Provider Business Mailing Address
First Line	:	1734 N RIVERSIDE AVE
Second Line	:	SUITE 2
City	:	RIALTO
State	:	CA
Zip	:	92376-8058
Country	:	US
Telephone Number	:	909-875-3595
Fax Number	:	909-875-1029

Provider Business Practice Location Address
First Line	:	1734 N RIVERSIDE AVE
Second Line	:	SUITE 2
City	:	RIALTO
State	:	CA
Zip	:	92376-8058
Country	:	US
Telephone Number	:	909-875-3595
Fax Number	:	909-875-1029

Authorized Official
Title or Position	:	PRESIDENT
Name	:	SUN C SOUNG
Credential	:	M.D.
Telephone Number	:	909-875-3595

Provider Enumeration Date	:	11/10/2009
Last Update Date	:	11/10/2009

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