Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 2080A0000X | Adolescent Medicine | 25MA08557700 | NJ |
NPI | 1235373010 |
---|---|
Provider Name | Dr. Boram Sung |
First Address | East Brunswick, NJ 08816-5601 |
Second Address | East Brunswick, NJ 08816-5601 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 24/04/2009 |
Last Update Date | 24/04/2009 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
222130958 | TAX ID (01) | NJ |