Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 208000000X | Pediatrician | 240997 | NY |
NPI | 1013015809 |
---|---|
Provider Name | Jenny Sung |
First Address | Hawthorne, NY 10532-2140 |
Second Address | Poughkeepsie, NY 12601-1154 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/09/2006 |
Last Update Date | 17/09/2020 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
02797877 | (05) | NY |