Provider Demographics
NPI:1679500888
Name:YIM, SUNG C (MD)
Entity type:Individual
Prefix:
First Name:SUNG
Middle Name:C
Last Name:YIM
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 FOREST DR
Mailing Address - Street 2:
Mailing Address - City:SANDS POINT
Mailing Address - State:NY
Mailing Address - Zip Code:11050-1910
Mailing Address - Country:US
Mailing Address - Phone:516-944-2470
Mailing Address - Fax:
Practice Address - Street 1:17 FOREST DR
Practice Address - Street 2:
Practice Address - City:SANDS POINT
Practice Address - State:NY
Practice Address - Zip Code:11050-1910
Practice Address - Country:US
Practice Address - Phone:516-944-2470
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY124822174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY0436457Medicaid
NY0436457Medicaid
NYB13665Medicare UPIN