Provider Demographics
NPI:1962545988
Name:ONGG, SUN YI (MD)
Entity type:Individual
Prefix:DR
First Name:SUN
Middle Name:YI
Last Name:ONGG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:33-16 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:ASTORIA
Mailing Address - State:NY
Mailing Address - Zip Code:11106-1806
Mailing Address - Country:US
Mailing Address - Phone:718-626-6010
Mailing Address - Fax:
Practice Address - Street 1:33-16 BROADWAY
Practice Address - Street 2:
Practice Address - City:ASTORIA
Practice Address - State:NY
Practice Address - Zip Code:11106-1806
Practice Address - Country:US
Practice Address - Phone:718-626-6010
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-15
Last Update Date:2008-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY137272207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY82L740OtherBLUE SHIELD
NY0043683OtherGHI
NY00523868Medicaid
NYC10067Medicare UPIN
NY0043683OtherGHI