Provider Demographics
NPI:1437338753
Name:SHON, SEUNG K (DDS)
Entity Type:Individual
Prefix:DR
First Name:SEUNG
Middle Name:K
Last Name:SHON
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:PO BOX 3159
Mailing Address - Street 2:
Mailing Address - City:WRIGHTWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:92397-3159
Mailing Address - Country:US
Mailing Address - Phone:760-249-5411
Mailing Address - Fax:760-249-3561
Practice Address - Street 1:1329 HWY 2
Practice Address - Street 2:STE C
Practice Address - City:WRIGHTWOOD
Practice Address - State:CA
Practice Address - Zip Code:92397
Practice Address - Country:US
Practice Address - Phone:760-249-5411
Practice Address - Fax:760-249-3561
Is Sole Proprietor?:Yes
Enumeration Date:2007-11-02
Last Update Date:2013-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA531071223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice