Provider Demographics
NPI:1154443075
Name:SUN, HAIXIONG (DDS)
Entity Type:Individual
Prefix:
First Name:HAIXIONG
Middle Name:
Last Name:SUN
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 1:328 S ATLANTIC BLVD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MONTEREY PARK
Mailing Address - State:CA
Mailing Address - Zip Code:91754-3242
Mailing Address - Country:US
Mailing Address - Phone:626-300-8838
Mailing Address - Fax:626-300-8339
Practice Address - Street 1:328 S ATLANTIC BLVD
Practice Address - Street 2:SUITE 201
Practice Address - City:MONTEREY PARK
Practice Address - State:CA
Practice Address - Zip Code:91754-3242
Practice Address - Country:US
Practice Address - Phone:626-300-8838
Practice Address - Fax:626-300-8339
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46979122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist