Provider Demographics
NPI:1730318684
Name:KIM, SUN CHUN (DDS)
Entity Type:Individual
Prefix:DR
First Name:SUN
Middle Name:CHUN
Last Name:KIM
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2645 N BERKELEY LAKE RD NW # A201
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:GA
Mailing Address - Zip Code:30096-3002
Mailing Address - Country:US
Mailing Address - Phone:470-545-1096
Mailing Address - Fax:470-200-0621
Practice Address - Street 1:2645 N BERKELEY LAKE RD NW # A201
Practice Address - Street 2:
Practice Address - City:DULUTH
Practice Address - State:GA
Practice Address - Zip Code:30096-3002
Practice Address - Country:US
Practice Address - Phone:470-545-1096
Practice Address - Fax:470-200-0621
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-13
Last Update Date:2024-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GADN0139431223G0001X
NMDD33981223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
GADN 013943OtherGEORGIA BOARD OF DENTISTRY
NMDD3398OtherNEW MEXICO BOARD OF DENTAL CARE