Provider Demographics
NPI:1730635111
Name:SUN, JINYU (DDS)
Entity Type:Individual
Prefix:
First Name:JINYU
Middle Name:
Last Name:SUN
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 1:610 PROFESSIONAL DR
Mailing Address - Street 2:SUITE 215
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3413
Mailing Address - Country:US
Mailing Address - Phone:301-869-8666
Mailing Address - Fax:
Practice Address - Street 1:13232 HUNT RDG
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-1153
Practice Address - Country:US
Practice Address - Phone:410-491-8686
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-26
Last Update Date:2016-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16144122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist