Provider Demographics
NPI:1659491009
Name:SUN, ANGEL (DDS)
Entity Type:Individual
Prefix:DR
First Name:ANGEL
Middle Name:
Last Name:SUN
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 1:3905 PARK DR
Mailing Address - Street 2:SUITE 205
Mailing Address - City:EL DORADO HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:95762-4564
Mailing Address - Country:US
Mailing Address - Phone:916-939-6900
Mailing Address - Fax:916-939-6970
Practice Address - Street 1:3905 PARK DR
Practice Address - Street 2:SUITE 205
Practice Address - City:EL DORADO HILLS
Practice Address - State:CA
Practice Address - Zip Code:95762-4564
Practice Address - Country:US
Practice Address - Phone:916-939-6900
Practice Address - Fax:916-939-6970
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA538761223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice