Provider Demographics
NPI:1780100065
Name:WANG, SARAH SUN YOUNG (DDS)
Entity type:Individual
Prefix:DR
First Name:SARAH
Middle Name:SUN YOUNG
Last Name:WANG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:SUN YOUNG
Other - Middle Name:
Other - Last Name:PARK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DDS
Mailing Address - Street 1:6315 VISTA DEL BOSQUE DR NW
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87120-2770
Mailing Address - Country:US
Mailing Address - Phone:310-429-4563
Mailing Address - Fax:
Practice Address - Street 1:1514 COORS BLVD NW
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87121-1105
Practice Address - Country:US
Practice Address - Phone:505-257-2000
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-17
Last Update Date:2022-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMDD47841223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice