Provider Demographics
NPI:1609912971
Name:BAO LAN SUN DDS IINC
Entity Type:Organization
Organization Name:BAO LAN SUN DDS IINC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:BAO LAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:661-799-8800
Mailing Address - Street 1:23450 LYONS AVE
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5778
Mailing Address - Country:US
Mailing Address - Phone:661-799-8800
Mailing Address - Fax:661-799-2805
Practice Address - Street 1:23450 LYONS AVE
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5778
Practice Address - Country:US
Practice Address - Phone:661-799-8800
Practice Address - Fax:661-799-2805
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-30
Last Update Date:2010-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9241001Medicare ID - Type UnspecifiedDENTICAL ID NUMBER