Provider Demographics
NPI:1164702072
Name:RUEHE, AMITA SUNG (DDS)
Entity Type:Individual
Prefix:DR
First Name:AMITA
Middle Name:SUNG
Last Name:RUEHE
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:DR
Other - First Name:AMITA
Other - Middle Name:SUNG
Other - Last Name:GHIYA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:2640 TELEGRAPH AVE STE 101
Mailing Address - Street 2:
Mailing Address - City:BERKELEY
Mailing Address - State:CA
Mailing Address - Zip Code:94704-3374
Mailing Address - Country:US
Mailing Address - Phone:510-848-6494
Mailing Address - Fax:
Practice Address - Street 1:2640 TELEGRAPH AVE STE 101
Practice Address - Street 2:
Practice Address - City:BERKELEY
Practice Address - State:CA
Practice Address - Zip Code:94704-3374
Practice Address - Country:US
Practice Address - Phone:510-848-6494
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-23
Last Update Date:2022-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608001223G0001X, 1223P0221X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0221XDental ProvidersDentistPediatric Dentistry
No1223G0001XDental ProvidersDentistGeneral Practice