Provider Demographics
NPI:1710160338
Name:SUN, BAO LAN (DDS)
Entity Type:Individual
Prefix:DR
First Name:BAO LAN
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 1:23450 LYONS AVE STE B
Mailing Address - Street 2:
Mailing Address - City:NEWHALL
Mailing Address - State:CA
Mailing Address - Zip Code:91321-5780
Mailing Address - Country:US
Mailing Address - Phone:661-799-8800
Mailing Address - Fax:661-799-2805
Practice Address - Street 1:23450 LYONS AVE STE B
Practice Address - Street 2:
Practice Address - City:NEWHALL
Practice Address - State:CA
Practice Address - Zip Code:91321-5780
Practice Address - Country:US
Practice Address - Phone:661-799-8800
Practice Address - Fax:661-799-2805
Is Sole Proprietor?:No
Enumeration Date:2007-12-06
Last Update Date:2009-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA40737122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAG9241001OtherDENTI-CAL ID