Provider Demographics
NPI:1700625134
Name:SUNG, BAWI THLUAI (NP)
Entity type:Individual
Prefix:
First Name:BAWI
Middle Name:THLUAI
Last Name:SUNG
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:165 BRALAN LN
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1662
Mailing Address - Country:US
Mailing Address - Phone:301-312-7105
Mailing Address - Fax:
Practice Address - Street 1:3154 CEDAR GROVE DR
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22031-1708
Practice Address - Country:US
Practice Address - Phone:301-312-7105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-24
Last Update Date:2024-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024190263363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily