Provider Demographics
NPI:1588687222
Name:SUNG, ELLEN (MD)
Entity type:Individual
Prefix:DR
First Name:ELLEN
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 1:3301 C ST
Mailing Address - Street 2:SUITE #200-E
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-3300
Mailing Address - Country:US
Mailing Address - Phone:916-447-6267
Mailing Address - Fax:916-447-0621
Practice Address - Street 1:3301 C ST
Practice Address - Street 2:SUITE #200-E
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-3300
Practice Address - Country:US
Practice Address - Phone:916-447-6267
Practice Address - Fax:916-447-0621
Is Sole Proprietor?:No
Enumeration Date:2006-07-25
Last Update Date:2008-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG54434174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174400000XOther Service ProvidersSpecialist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAAN867YOtherPALMETTO GBA GROUP PTAN
CAAN876ZOtherPALMETTO GBA GROUP PTAN
CA00G544340Medicaid
CAAN867WOtherPALMETTO GBA GROUP PTAN
CAAN867SOtherPALMETTO GBA GROUP PTAN
CAAN867UOtherPALMETTO GBA GROUP PTAN
CAAN867VOtherPALMETTO GBA GROUP PTAN
CAAN867TOtherPALMETTO GBA GROUP PTAN
CAAN867XOtherPALMETTO GBA GROUP PTAN
CAAN867UOtherPALMETTO GBA GROUP PTAN
CAAN867XOtherPALMETTO GBA GROUP PTAN
CAAN867WOtherPALMETTO GBA GROUP PTAN
CA00G544340Medicaid