Provider Demographics
NPI:1497982284
Name:YI, SU-CHUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SU-CHUN
Middle Name:
Last Name:YI
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:DR
Other - First Name:CHRIS
Other - Middle Name:SU-CHUN
Other - Last Name:LEE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DDS
Mailing Address - Street 1:8470 FALLS OF NEUSE RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:RALEIGH
Mailing Address - State:NC
Mailing Address - Zip Code:27615
Mailing Address - Country:US
Mailing Address - Phone:919-977-0627
Mailing Address - Fax:919-977-4079
Practice Address - Street 1:3415 ROGERS RD.
Practice Address - Street 2:SUITE 100
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587
Practice Address - Country:US
Practice Address - Phone:919-554-9955
Practice Address - Fax:919-554-9933
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2016-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC8794122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist