MEDICARE: DR. SUN CHUNG SOUNG M.D.

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	207R00000X	Internal Medicine Physician	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	:	1295893162
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. SUN CHUNG SOUNG M.D.

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	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/04/2006
Last Update Date	:	07/08/2007

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