Provider Demographics
NPI:1295201085
Name:SOHN, SUN YOUNG (DDS)
Entity Type:Individual
Prefix:
First Name:SUN YOUNG
Middle Name:
Last Name:SOHN
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 1:17060 HIDDEN TRAILS LN
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-6795
Mailing Address - Country:US
Mailing Address - Phone:909-963-6688
Mailing Address - Fax:
Practice Address - Street 1:1374 W FOOTHILL BLVD # 2E
Practice Address - Street 2:
Practice Address - City:RIALTO
Practice Address - State:CA
Practice Address - Zip Code:92376-4621
Practice Address - Country:US
Practice Address - Phone:909-874-7444
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-10-18
Last Update Date:2020-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA103123122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist