Provider Demographics
NPI:1922218510
Name:SUN, TAO TE (DDS)
Entity Type:Individual
Prefix:DR
First Name:TAO
Middle Name:TE
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 1:485 E 17TH ST
Mailing Address - Street 2:103
Mailing Address - City:COSTA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:92627-3265
Mailing Address - Country:US
Mailing Address - Phone:949-645-8887
Mailing Address - Fax:
Practice Address - Street 1:485 E 17TH ST
Practice Address - Street 2:103
Practice Address - City:COSTA MESA
Practice Address - State:CA
Practice Address - Zip Code:92627-3265
Practice Address - Country:US
Practice Address - Phone:949-645-8887
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA46221122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist