Basic Information
| Provider Information | |||||||||
| NPI: | 1942270749 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SUNG | ||||||||
| FirstName: | KAP-JAE | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | M.D. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5645 MAIN ST | ||||||||
| Address2: | W-LL300 | ||||||||
| City: | FLUSHING | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113555045 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186702127 | ||||||||
| FaxNumber: | 3473289362 | ||||||||
| Practice Location | |||||||||
| Address1: | 6683 70TH ST | ||||||||
| Address2: | |||||||||
| City: | MIDDLE VILLAGE | ||||||||
| State: | NY | ||||||||
| PostalCode: | 113791739 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7186512929 | ||||||||
| FaxNumber: | 7186513521 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/24/2006 | ||||||||
| LastUpdateDate: | 07/28/2014 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208600000X | 161256 | NY | Y | Allopathic & Osteopathic Physicians | Surgery |
ID Information
| ID | Type | State | Issuer | Description | 00956318 | 05 | NY | MEDICAID | 03487616 | 05 | NY | MEDICAID |