Provider Demographics
NPI:1912292574
Name:SUNG, JINHEE
Entity type:Individual
Prefix:
First Name:JINHEE
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3749 CARPENTER RD
Mailing Address - Street 2:T-1285
Mailing Address - City:YPSILANTI
Mailing Address - State:MI
Mailing Address - Zip Code:48197-9809
Mailing Address - Country:US
Mailing Address - Phone:734-975-4675
Mailing Address - Fax:734-975-4675
Practice Address - Street 1:3749 CARPENTER RD
Practice Address - Street 2:T-1285
Practice Address - City:YPSILANTI
Practice Address - State:MI
Practice Address - Zip Code:48197-9809
Practice Address - Country:US
Practice Address - Phone:734-975-4675
Practice Address - Fax:734-975-4675
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-12
Last Update Date:2011-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302032913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist