Provider Demographics
NPI:1316331887
Name:SUNGHYE MED CORP
Entity type:Organization
Organization Name:SUNGHYE MED CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PSYCHOLOGISY
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNG
Authorized Official - Middle Name:
Authorized Official - Last Name:YI
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-493-7256
Mailing Address - Street 1:1020 S ANAHEIM BLVD
Mailing Address - Street 2:SUITE 209
Mailing Address - City:ANAHEIM
Mailing Address - State:CA
Mailing Address - Zip Code:92805-5851
Mailing Address - Country:US
Mailing Address - Phone:714-493-7258
Mailing Address - Fax:
Practice Address - Street 1:1020 S ANAHEIM BLVD
Practice Address - Street 2:SUITE 209
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92805-5851
Practice Address - Country:US
Practice Address - Phone:714-493-7258
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-23
Last Update Date:2015-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY17357323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA1578606240Medicare UPIN
CACP17357Medicare PIN