Provider Demographics
NPI:1659613610
Name:HAM, SUNDO (DENTIST)
Entity Type:Individual
Prefix:DR
First Name:SUNDO
Middle Name:
Last Name:HAM
Suffix:
Gender:M
Credentials:DENTIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 W OLYMPIC BLVD
Mailing Address - Street 2:STE 202
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90006-2859
Mailing Address - Country:US
Mailing Address - Phone:213-386-6700
Mailing Address - Fax:213-386-6706
Practice Address - Street 1:3800 WILSHIRE BLVD # 207
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90010-3231
Practice Address - Country:US
Practice Address - Phone:213-386-6700
Practice Address - Fax:213-386-6706
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-17
Last Update Date:2016-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA620311223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice