Provider Demographics
NPI:1134100266
Name:SUEN, HALTON (DDS)
Entity Type:Individual
Prefix:DR
First Name:HALTON
Middle Name:
Last Name:SUEN
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 8TH ST
Mailing Address - Street 2:STE 2D
Mailing Address - City:OAKLAND
Mailing Address - State:CA
Mailing Address - Zip Code:94607-4260
Mailing Address - Country:US
Mailing Address - Phone:510-268-8888
Mailing Address - Fax:510-268-8282
Practice Address - Street 1:320 8TH ST
Practice Address - Street 2:STE 2D
Practice Address - City:OAKLAND
Practice Address - State:CA
Practice Address - Zip Code:94607-4260
Practice Address - Country:US
Practice Address - Phone:510-268-8888
Practice Address - Fax:510-268-8282
Is Sole Proprietor?:No
Enumeration Date:2005-11-07
Last Update Date:2009-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAB31536011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAB31536Medicaid