Provider Demographics
NPI:1881043321
Name:BYUN, SANGHO (DDS)
Entity Type:Individual
Prefix:DR
First Name:SANGHO
Middle Name:
Last Name:BYUN
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 1:301 S FAIR OAKS AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:PASADENA
Mailing Address - State:CA
Mailing Address - Zip Code:91105-2536
Mailing Address - Country:US
Mailing Address - Phone:626-796-3161
Mailing Address - Fax:
Practice Address - Street 1:301 S FAIR OAKS AVE STE 204
Practice Address - Street 2:
Practice Address - City:PASADENA
Practice Address - State:CA
Practice Address - Zip Code:91105-2536
Practice Address - Country:US
Practice Address - Phone:626-796-3161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-06-06
Last Update Date:2019-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA608061223P0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223P0700XDental ProvidersDentistProsthodontics