Provider Demographics
NPI:1225809262
Name:SUL, BO KYUNG (NP)
Entity type:Individual
Prefix:
First Name:BO KYUNG
Middle Name:
Last Name:SUL
Suffix:
Gender:
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7022 LOGSDON DR
Mailing Address - Street 2:
Mailing Address - City:EASTVALE
Mailing Address - State:CA
Mailing Address - Zip Code:92880-3997
Mailing Address - Country:US
Mailing Address - Phone:213-797-2459
Mailing Address - Fax:
Practice Address - Street 1:12291 WASHINGTON BLVD STE 201
Practice Address - Street 2:
Practice Address - City:WHITTIER
Practice Address - State:CA
Practice Address - Zip Code:90606-2549
Practice Address - Country:US
Practice Address - Phone:562-698-0306
Practice Address - Fax:562-789-5458
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2025-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027697363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner