Provider Demographics
NPI:1548358146
Name:JUN, SUNGHO (MD)
Entity type:Individual
Prefix:
First Name:SUNGHO
Middle Name:
Last Name:JUN
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 1:2559 MEDICAL DR
Mailing Address - Street 2:STE B
Mailing Address - City:ALAMOGORDO
Mailing Address - State:NM
Mailing Address - Zip Code:88310-8703
Mailing Address - Country:US
Mailing Address - Phone:505-437-8828
Mailing Address - Fax:505-437-4122
Practice Address - Street 1:2559 MEDICAL DR
Practice Address - Street 2:STE B
Practice Address - City:ALAMOGORDO
Practice Address - State:NM
Practice Address - Zip Code:88310-8703
Practice Address - Country:US
Practice Address - Phone:505-437-8828
Practice Address - Fax:505-437-4122
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2007-10-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NM9681207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
NMP3209Medicaid
NM1201OtherBCBS
NM1201OtherBCBS