Provider Demographics
NPI:1689006629
Name:SUN OK SUK, DDS, PC
Entity Type:Organization
Organization Name:SUN OK SUK, DDS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SUN
Authorized Official - Middle Name:OK
Authorized Official - Last Name:SUK
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:703-698-5400
Mailing Address - Street 1:2136 GALLOWS RD STE B
Mailing Address - Street 2:
Mailing Address - City:DUNN LORING
Mailing Address - State:VA
Mailing Address - Zip Code:22027-1036
Mailing Address - Country:US
Mailing Address - Phone:703-698-5400
Mailing Address - Fax:703-641-0237
Practice Address - Street 1:2136 GALLOWS RD STE B
Practice Address - Street 2:
Practice Address - City:DUNN LORING
Practice Address - State:VA
Practice Address - Zip Code:22027-1036
Practice Address - Country:US
Practice Address - Phone:703-698-5400
Practice Address - Fax:703-641-0237
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-01
Last Update Date:2013-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0401006359261QD0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010292972Medicare PIN