Provider Demographics
NPI:1114590791
Name:SUNGA, JOHN CRISTOPHER (IDMT)
Entity type:Individual
Prefix:
First Name:JOHN CRISTOPHER
Middle Name:
Last Name:SUNGA
Suffix:
Gender:M
Credentials:IDMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:823 LOTZ WAY
Mailing Address - Street 2:
Mailing Address - City:SUISUN CITY
Mailing Address - State:CA
Mailing Address - Zip Code:94585-2601
Mailing Address - Country:US
Mailing Address - Phone:757-202-7972
Mailing Address - Fax:
Practice Address - Street 1:E. 9TH STREET BUILDING NUMBER 421
Practice Address - Street 2:
Practice Address - City:KUNSAN AB
Practice Address - State:GUNSAN CITY
Practice Address - Zip Code:54168
Practice Address - Country:KR
Practice Address - Phone:063-782-4126
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-21
Last Update Date:2022-08-30
Deactivation Date:
Deactivation Code:
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1710I1003XOther Service ProvidersMilitary Health Care ProviderIndependent Duty Medical Technicians