Provider Demographics
NPI:1740472950
Name:SHYN, SUNG SOO (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNG
Middle Name:SOO
Last Name:SHYN
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:PO BOX 27425
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93729-7425
Mailing Address - Country:US
Mailing Address - Phone:559-325-8000
Mailing Address - Fax:559-325-6989
Practice Address - Street 1:355 MONTE VISTA DR STE D
Practice Address - Street 2:
Practice Address - City:DINUBA
Practice Address - State:CA
Practice Address - Zip Code:93618-9229
Practice Address - Country:US
Practice Address - Phone:559-596-0300
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-08-11
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CADDS508621223X0400X
FLDN 166061223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics