Provider Demographics
NPI:1831476076
Name:SUN, RACHEL (DMD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:147 ROOSEVELT AVE
Mailing Address - Street 2:UNIT 15C
Mailing Address - City:FLUSHING
Mailing Address - State:NY
Mailing Address - Zip Code:11354-4757
Mailing Address - Country:US
Mailing Address - Phone:646-596-5134
Mailing Address - Fax:
Practice Address - Street 1:147 ROOSEVELT AVE
Practice Address - Street 2:UNIT 15C
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4757
Practice Address - Country:US
Practice Address - Phone:646-596-5134
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-15
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053023122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist