Individual provider Active NPI

Ki Ro Sung, R. PH.

  • Pharmacist
  • Flushing, NY
National Provider Identifier
1205906112
Registry record updated Nov 20, 2007
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
029347 Issued in NY
Practice address
13673 41St Ave
Flushing, NY 11355-2433
Phone
(718) 358-3800
Fax
(718) 358-7615
NPI assigned
Nov 8, 2006
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Nov 20, 2007

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X 029347 NY Primary

Addresses

Primary practice location

13673 41St Ave
Flushing, NY 11355-2433

Mailing address

13673 41St Ave
Flushing, NY 11355-2433
Phone (718) 358-3800

Other identifiers 1

IdentifierTypeStateIssuer
00893370MedicaidNY

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Pharmacist

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1162944000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1195516800000",
    "number": "1205906112",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "13673 41ST AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552433",
            "telephone_number": "718-358-3800",
            "fax_number": "718-358-7615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13673 41ST AVE",
            "city": "FLUSHING",
            "state": "NY",
            "postal_code": "113552433",
            "telephone_number": "718-358-3800",
            "fax_number": "718-358-7615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUNG",
        "first_name": "KI RO",
        "credential": "R. PH.",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2006-11-08",
        "last_updated": "2007-11-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "NY",
            "license": "029347",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00893370",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Flushing, NY

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 20, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.