Provider Demographics
NPI:1700638335
Name:HUN, SREYNOCH (DMD)
Entity Type:Individual
Prefix:
First Name:SREYNOCH
Middle Name:
Last Name:HUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:SREY
Other - Middle Name:NOCH
Other - Last Name:LACH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2201 S HIGHLAND AVE APT 4J
Mailing Address - Street 2:
Mailing Address - City:LOMBARD
Mailing Address - State:IL
Mailing Address - Zip Code:60148-5347
Mailing Address - Country:US
Mailing Address - Phone:323-283-2055
Mailing Address - Fax:
Practice Address - Street 1:13510 JULIE DR
Practice Address - Street 2:
Practice Address - City:POPLAR GROVE
Practice Address - State:IL
Practice Address - Zip Code:61065-7829
Practice Address - Country:US
Practice Address - Phone:815-765-4003
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-05
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program