Provider Demographics
NPI:1629189402
Name:SUEN, LUP CHUNG (DMD)
Entity Type:Individual
Prefix:DR
First Name:LUP CHUNG
Middle Name:
Last Name:SUEN
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1215 PLUMAS ST
Mailing Address - Street 2:SUITE #52
Mailing Address - City:YUBA CITY
Mailing Address - State:CA
Mailing Address - Zip Code:95991-3455
Mailing Address - Country:US
Mailing Address - Phone:530-755-9968
Mailing Address - Fax:530-755-4557
Practice Address - Street 1:1215 PLUMAS ST
Practice Address - Street 2:SUITE #52
Practice Address - City:YUBA CITY
Practice Address - State:CA
Practice Address - Zip Code:95991-3455
Practice Address - Country:US
Practice Address - Phone:530-755-9968
Practice Address - Fax:530-755-4557
Is Sole Proprietor?:No
Enumeration Date:2006-08-31
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA395051223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice