Basic Information
| Provider Information | |||||||||
| NPI: | 1194769810 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BYUN | ||||||||
| FirstName: | SUNG | ||||||||
| MiddleName: | TAE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | MD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4371 VERONICA S SHOEMAKER BLVD | ||||||||
| Address2: | ATTN CREDENTIALING | ||||||||
| City: | FORT MYERS | ||||||||
| State: | FL | ||||||||
| PostalCode: | 339162216 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2392748200 | ||||||||
| FaxNumber: | 2392783350 | ||||||||
| Practice Location | |||||||||
| Address1: | 8787 BRYAN DAIRY RD | ||||||||
| Address2: | SUITE 210 | ||||||||
| City: | LARGO | ||||||||
| State: | FL | ||||||||
| PostalCode: | 337771251 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7273979641 | ||||||||
| FaxNumber: | 7273934194 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2006 | ||||||||
| LastUpdateDate: | 08/03/2015 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207RH0003X | ME72379 | FL | Y | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology & Oncology | 207RX0202X | ME72379 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Medical Oncology | 207RH0000X | ME72379 | FL | N | Allopathic & Osteopathic Physicians | Internal Medicine | Hematology |
ID Information
| ID | Type | State | Issuer | Description | 261657200 | 05 | FL | MEDICAID | 830003154 | 01 | FL | RAILROAD MEDICARE | OTHER |