1275520892 NPI number — YOU SUNG SANG M.D.

Table of content: YOU SUNG SANG M.D. (NPI 1275520892)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1275520892 NPI number — YOU SUNG SANG M.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SANG
Provider First Name:
YOU SUNG
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.D.
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1275520892
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/15/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
105 WAWECUS ST
Provider Second Line Business Mailing Address:
SUITE 1
Provider Business Mailing Address City Name:
NORWICH
Provider Business Mailing Address State Name:
CT
Provider Business Mailing Address Postal Code:
06360-2146
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
860-859-9061
Provider Business Mailing Address Fax Number:
860-889-6200

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 WAWECUS ST
Provider Second Line Business Practice Location Address:
SUITE 1
Provider Business Practice Location Address City Name:
NORWICH
Provider Business Practice Location Address State Name:
CT
Provider Business Practice Location Address Postal Code:
06360-2146
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
860-859-9061
Provider Business Practice Location Address Fax Number:
860-889-6200
Provider Enumeration Date:
09/29/2005

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 207RG0100X , with the licence number:  034513 , registered in the state of CT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2543591 . This is a "AETNA HMO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 345130 . This is a "CONNECTICARE" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 5860483 . This is a "AETNA PPO" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: NLS084 . This is a "OXFORD HEALTH PLAN" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".
  • Identifier: 010034513CT01 . This is a "ANTHEM BCBS OF CT" identifier , issued by the state of ( CT ) . This identifiers is of the category "OTHER".




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