Provider Demographics
NPI:1407372154
Name:SUN, HO HYUN BRIAN (DMD)
Entity Type:Individual
Prefix:
First Name:HO HYUN
Middle Name:BRIAN
Last Name:SUN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:HO-HYUN
Other - Middle Name:
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD
Mailing Address - Street 1:2025 FOREST AVE STE 6
Mailing Address - Street 2:
Mailing Address - City:SAN JOSE
Mailing Address - State:CA
Mailing Address - Zip Code:95128-4806
Mailing Address - Country:US
Mailing Address - Phone:408-286-1553
Mailing Address - Fax:
Practice Address - Street 1:2025 FOREST AVE STE 6
Practice Address - Street 2:
Practice Address - City:SAN JOSE
Practice Address - State:CA
Practice Address - Zip Code:95128-4806
Practice Address - Country:US
Practice Address - Phone:408-770-9496
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-08-15
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1015771223S0112X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223S0112XDental ProvidersDentistOral and Maxillofacial Surgery