NPIMap

Organization Active NPI

Sue Jung Inc

  • Community/Retail Pharmacy
  • Los Angeles, CA
National Provider Identifier
1457362048
Registry record updated Dec 31, 2015
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community/Retail PharmacyTaxonomy code 3336C0003X
License
PHY45763 Issued in CA
Legal business name
SUE JUNG INC
Doing business as
ETHICAL DRUG
Practice address
254 N Western Ave
Los Angeles, CA 90004-4108
Phone
(323) 467-2101
Fax
(323) 469-8615
NPI assigned
Aug 10, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 31, 2015

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

Authorized official

Name
Sang Jeon
Title
President
Phone
(323) 467-2101

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacy 333600000X
Community/Retail Pharmacy 3336C0003X PHY45763 CA Primary

Addresses

Primary practice location

254 N Western Ave
Los Angeles, CA 90004-4108

Mailing address

254 N Western Ave
Los Angeles, CA 90004-4108
Phone (323) 467-2101

Other identifiers 2

IdentifierTypeStateIssuer
2002596OtherPK
PHA457630MedicaidCA

Other names 1

  • ETHICAL DRUG Doing business as

National Provider Directory

National Provider Directory
Tax ID family
Ethical Drug2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

Locations

254 N Western Ave
Los Angeles, CA 90004
Phone (323) 467-2101

Practitioners & affiliated clinicians

Practitioners 2

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1155168000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1451520000000",
    "number": "1457362048",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "254 N WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044108",
            "telephone_number": "323-467-2101",
            "fax_number": "323-469-8615"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "254 N WESTERN AVE",
            "city": "LOS ANGELES",
            "state": "CA",
            "postal_code": "900044108",
            "telephone_number": "323-467-2101",
            "fax_number": "323-469-8615"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SUE JUNG INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-10",
        "last_updated": "2015-12-31",
        "status": "A",
        "authorized_official_last_name": "JEON",
        "authorized_official_first_name": "SANG",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "323-467-2101"
    },
    "taxonomies": [
        {
            "code": "333600000X",
            "taxonomy_group": "",
            "desc": "Pharmacy",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "CA",
            "license": "PHY45763",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PK",
            "identifier": "2002596",
            "state": null
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "PHA457630",
            "state": "CA"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "ETHICAL DRUG",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

Other providers in Los Angeles, CA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 31, 2015; 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.