Ill Sung NA, MD

Primary specialty

Family Medicine PhysicianTaxonomy code 207Q00000X

License

154224 Issued in NY

Practice address

477 Willis Ave
Narco Freedom
Bronx, NY 10455-4015

Phone

(718) 292-4640

Fax

(718) 292-4640

NPI assigned

Sep 14, 2006

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Medicine

State licenses

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

{
    "created_epoch": "1158192000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1379894400000",
    "number": "1942305685",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "477 WILLIS AVE",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554015",
            "telephone_number": "718-292-4640",
            "fax_number": "718-292-4640"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "477 WILLIS AVE",
            "address_2": "NARCO FREEDOM",
            "city": "BRONX",
            "state": "NY",
            "postal_code": "104554015",
            "telephone_number": "718-292-4640",
            "fax_number": "718-292-4640"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "NA",
        "first_name": "ILL SUNG",
        "name_prefix": "Dr.",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2006-09-14",
        "last_updated": "2013-09-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "207Q00000X",
            "taxonomy_group": "",
            "desc": "Family Medicine",
            "state": "NY",
            "license": "154224",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "00787875",
            "state": "NY"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Family Medicine Physician in Bronx, NY
• Providers in Bronx, NY by specialty
• Family Medicine Physician in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 23, 2013; 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.