Provider Demographics
NPI:1144423278
Name:SUN, TINA (DDS)
Entity Type:Individual
Prefix:
First Name:TINA
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:877 W EL REPETTO DR APT 50A
Mailing Address - Street 2:
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-5245
Mailing Address - Country:US
Mailing Address - Phone:626-676-2588
Mailing Address - Fax:
Practice Address - Street 1:18645 GALE AVE STE 180
Practice Address - Street 2:
Practice Address - City:CITY OF INDUSTRY
Practice Address - State:CA
Practice Address - Zip Code:91748-1370
Practice Address - Country:US
Practice Address - Phone:626-641-1388
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA511381223P0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0300XDental ProvidersDentistPeriodontics