Provider Demographics
NPI:1942712526
Name:SUNDO HAM, DDS. INC.
Entity Type:Organization
Organization Name:SUNDO HAM, DDS. INC.
Other - Org Name:SUNDO HAM, DDS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SUJIN
Authorized Official - Middle Name:
Authorized Official - Last Name:YU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:213-369-5330
Mailing Address - Street 1:711 S VERMONT AVE STE 111
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90005-1587
Mailing Address - Country:US
Mailing Address - Phone:213-387-2325
Mailing Address - Fax:213-387-0910
Practice Address - Street 1:711 S VERMONT AVE STE 111
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90005-1587
Practice Address - Country:US
Practice Address - Phone:213-387-2325
Practice Address - Fax:213-387-0910
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-11-03
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA62031122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty