Provider Demographics
NPI:1194786731
Name:SUNG, SOYOUNG (MD)
Entity type:Individual
Prefix:
First Name:SOYOUNG
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1955 1ST AVE N
Mailing Address - Street 2:
Mailing Address - City:ST PETERSBURG
Mailing Address - State:FL
Mailing Address - Zip Code:33713-8941
Mailing Address - Country:US
Mailing Address - Phone:727-894-3937
Mailing Address - Fax:727-821-0771
Practice Address - Street 1:1955 1ST AVE N
Practice Address - Street 2:
Practice Address - City:ST PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33713-8941
Practice Address - Country:US
Practice Address - Phone:727-894-3937
Practice Address - Fax:727-821-0771
Is Sole Proprietor?:No
Enumeration Date:2006-03-31
Last Update Date:2010-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 93577207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLU63222Medicare ID - Type Unspecified
FLH63703Medicare UPIN