Provider Demographics
NPI:1063995322
Name:SUNG, ISAAC (DPT)
Entity type:Individual
Prefix:
First Name:ISAAC
Middle Name:
Last Name:SUNG
Suffix:
Gender:M
Credentials:DPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3209 OSBORNE CT
Mailing Address - Street 2:
Mailing Address - City:CARMICHAEL
Mailing Address - State:CA
Mailing Address - Zip Code:95608-3628
Mailing Address - Country:US
Mailing Address - Phone:916-216-0347
Mailing Address - Fax:
Practice Address - Street 1:3209 OSBORNE CT
Practice Address - Street 2:
Practice Address - City:CARMICHAEL
Practice Address - State:CA
Practice Address - Zip Code:95608-3628
Practice Address - Country:US
Practice Address - Phone:916-216-0347
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-12
Last Update Date:2018-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA294680225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist