Provider Demographics
NPI:1457423451
Name:SUNG, JIN HO (DDS)
Entity Type:Individual
Prefix:DR
First Name:JIN HO
Middle Name:
Last Name:SUNG
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 1:5441 BEACH BLVD
Mailing Address - Street 2:
Mailing Address - City:BUENA PARK
Mailing Address - State:CA
Mailing Address - Zip Code:90621-1233
Mailing Address - Country:US
Mailing Address - Phone:714-670-2828
Mailing Address - Fax:714-670-2820
Practice Address - Street 1:5441 BEACH BLVD
Practice Address - Street 2:
Practice Address - City:BUENA PARK
Practice Address - State:CA
Practice Address - Zip Code:90621-1233
Practice Address - Country:US
Practice Address - Phone:714-670-2828
Practice Address - Fax:714-670-2820
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA35172122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist