Provider Demographics
NPI:1700195245
Name:UNITED FAMILY DENTIST, PC
Entity Type:Organization
Organization Name:UNITED FAMILY DENTIST, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:WAI-LUN
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:718-264-1188
Mailing Address - Street 1:22301 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3644
Mailing Address - Country:US
Mailing Address - Phone:718-264-1188
Mailing Address - Fax:718-264-1180
Practice Address - Street 1:22301 UNION TPKE
Practice Address - Street 2:
Practice Address - City:OAKLAND GARDENS
Practice Address - State:NY
Practice Address - Zip Code:11364-3644
Practice Address - Country:US
Practice Address - Phone:718-264-1188
Practice Address - Fax:718-264-1180
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-01
Last Update Date:2010-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY045033-01122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227907Medicaid