Provider Demographics
NPI:1750610390
Name:SUNG, SI YEUN (DDS)
Entity type:Individual
Prefix:MRS
First Name:SI YEUN
Middle Name:
Last Name:SUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18418 LAKEPOINTE DR
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92503-0252
Mailing Address - Country:US
Mailing Address - Phone:951-565-6133
Mailing Address - Fax:
Practice Address - Street 1:18418 LAKEPOINTE DR
Practice Address - Street 2:
Practice Address - City:RIVERSIDE
Practice Address - State:CA
Practice Address - Zip Code:92503-0252
Practice Address - Country:US
Practice Address - Phone:951-565-6133
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-10
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA585831223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice