Provider Demographics
NPI:1841415627
Name:SUN, JENNY C (DDS)
Entity Type:Individual
Prefix:
First Name:JENNY
Middle Name:C
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 1:231 N INDIAN HILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711
Mailing Address - Country:US
Mailing Address - Phone:909-624-7865
Mailing Address - Fax:909-626-0014
Practice Address - Street 1:231 N INDIAN HILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711
Practice Address - Country:US
Practice Address - Phone:909-624-7865
Practice Address - Fax:909-626-0014
Is Sole Proprietor?:No
Enumeration Date:2007-04-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33671122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist