Provider Demographics
NPI:1417336363
Name:SUNG, JESSICA T (DMD, MS)
Entity Type:Individual
Prefix:DR
First Name:JESSICA
Middle Name:T
Last Name:SUNG
Suffix:
Gender:F
Credentials:DMD, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1701 W IMPERIAL HWY
Mailing Address - Street 2:SUITE #B
Mailing Address - City:LA HABRA
Mailing Address - State:CA
Mailing Address - Zip Code:90631-0603
Mailing Address - Country:US
Mailing Address - Phone:562-475-4568
Mailing Address - Fax:
Practice Address - Street 1:1701 W IMPERIAL HWY
Practice Address - Street 2:SUITE #B
Practice Address - City:LA HABRA
Practice Address - State:CA
Practice Address - Zip Code:90631-0603
Practice Address - Country:US
Practice Address - Phone:562-475-4568
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-05-26
Last Update Date:2016-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS1008421223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice