Basic Information
| Provider Information | |||||||||
| NPI: | 1235594185 | ||||||||
| EntityType: | 1 | ||||||||
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| LastName: | SUNG | ||||||||
| FirstName: | EUNJAE | ||||||||
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| Credential: | CRNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 16020 S WESTERN AVE | ||||||||
| Address2: | STE 101 | ||||||||
| City: | GARDENA | ||||||||
| State: | CA | ||||||||
| PostalCode: | 902473743 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7164804363 | ||||||||
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| Practice Location | |||||||||
| Address1: | 11116 MEDICAL CAMPUS RD | ||||||||
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| City: | HAGERSTOWN | ||||||||
| State: | MD | ||||||||
| PostalCode: | 217426710 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3017908000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/18/2015 | ||||||||
| LastUpdateDate: | 08/13/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LA2200X | R218810 | MD | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Adult Health | 363LP2300X | 95010489 | CA | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Primary Care | 208M00000X | 0024174203 | VA | N | Allopathic & Osteopathic Physicians | Hospitalist |
No ID Information.