Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 207L00000X | Anesthesiologist | 25MA10830900 | NJ |
NPI | 1013370311 |
---|---|
Provider Name | Mr. Hee Chang Sung |
First Address | Fort Lee, NJ 07024-7346 |
Second Address | North Bergen, NJ 07047-6217 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 04/04/2016 |
Last Update Date | 01/02/2021 |