Provider Demographics
NPI:1447421912
Name:LYDON, SUNG (DDS)
Entity Type:Individual
Prefix:
First Name:SUNG
Middle Name:
Last Name:LYDON
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 1:4250 SCOTT DR
Mailing Address - Street 2:SUITE J
Mailing Address - City:NEWPORT BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92660-1932
Mailing Address - Country:US
Mailing Address - Phone:949-660-1321
Mailing Address - Fax:949-851-0856
Practice Address - Street 1:4250 SCOTT DR
Practice Address - Street 2:SUITE J
Practice Address - City:NEWPORT BEACH
Practice Address - State:CA
Practice Address - Zip Code:92660-1932
Practice Address - Country:US
Practice Address - Phone:949-660-1321
Practice Address - Fax:949-851-0856
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-12
Last Update Date:2008-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA485041223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice