Provider Demographics
NPI:1316249345
Name:SUNG, JENNY HYESIL (OD)
Entity type:Individual
Prefix:
First Name:JENNY
Middle Name:HYESIL
Last Name:SUNG
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:HYE
Other - Middle Name:SIL
Other - Last Name:SUNG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:1619 4TH AVE
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90019-6130
Mailing Address - Country:US
Mailing Address - Phone:323-528-1316
Mailing Address - Fax:
Practice Address - Street 1:1026 W WEST COVINA PKWY STE B
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790-8212
Practice Address - Country:US
Practice Address - Phone:626-962-5868
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-23
Last Update Date:2011-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA14001TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist