Provider Demographics
NPI:1962625160
Name:PAHNG, SUNG J (MD)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:J
Last Name:PAHNG
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21704 NORTHERN BLVD STE 2
Mailing Address - Street 2:
Mailing Address - City:BAYSIDE
Mailing Address - State:NY
Mailing Address - Zip Code:11361-3500
Mailing Address - Country:US
Mailing Address - Phone:718-353-6835
Mailing Address - Fax:718-353-6854
Practice Address - Street 1:21704 NORTHERN BLVD STE 2
Practice Address - Street 2:
Practice Address - City:BAYSIDE
Practice Address - State:NY
Practice Address - Zip Code:11361-3500
Practice Address - Country:US
Practice Address - Phone:718-353-6835
Practice Address - Fax:718-353-6854
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-10
Last Update Date:2014-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY188371225400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225400000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G10968Medicare UPIN
NY05609GMedicare ID - Type Unspecified