Provider Demographics
NPI:1598987893
Name:SUNGCHUN S. WEE, DDS, INC
Entity Type:Organization
Organization Name:SUNGCHUN S. WEE, DDS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUNGCHUN
Authorized Official - Middle Name:STEVEN
Authorized Official - Last Name:WEE
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:760-367-1100
Mailing Address - Street 1:71757 29 PALMS HWY
Mailing Address - Street 2:SUITE C
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277
Mailing Address - Country:US
Mailing Address - Phone:760-367-1100
Mailing Address - Fax:760-367-2033
Practice Address - Street 1:71757 29 PALMS HWY
Practice Address - Street 2:SUITE C
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277
Practice Address - Country:US
Practice Address - Phone:760-367-1100
Practice Address - Fax:760-367-2033
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA47335261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA857275OtherUNITED CONCORDIA
CA245907OtherTRIGON
CAG92915-01Medicaid
CA47335OtherDELTA DENTAL