Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 1223X0400X | Orthodontists | DE60561317 | WA |
NPI | 1033581640 |
---|---|
Provider Name | Jay Hyuck Sung |
First Address | Redmond, WA 98052 |
Second Address | University Place, WA 98466 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 22/10/2015 |
Last Update Date | 22/10/2015 |