Provider Demographics
NPI:1780073627
Name:KOO, SUNGJOON T (DMD)
Entity type:Individual
Prefix:
First Name:SUNGJOON
Middle Name:T
Last Name:KOO
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1870 N STONEBRIDGE DR # 110
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7443
Mailing Address - Country:US
Mailing Address - Phone:214-592-0692
Mailing Address - Fax:
Practice Address - Street 1:1870 N STONEBRIDGE DR # 110
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-7443
Practice Address - Country:US
Practice Address - Phone:214-592-0692
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-01-15
Last Update Date:2025-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX331211223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice