Provider Demographics
NPI:1255679767
Name:SUNG, KALVIN (DDS)
Entity Type:Individual
Prefix:
First Name:KALVIN
Middle Name:
Last Name:SUNG
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 1:5757 WILSHIRE BLVD STE 355
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90036-3628
Mailing Address - Country:US
Mailing Address - Phone:323-936-2106
Mailing Address - Fax:323-936-2108
Practice Address - Street 1:5757 WILSHIRE BLVD STE 355
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90036-3628
Practice Address - Country:US
Practice Address - Phone:323-936-2106
Practice Address - Fax:323-936-2108
Is Sole Proprietor?:No
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA48682122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist