Provider Demographics
NPI:1801930698
Name:SUNG, JOHN WAI-LUN (DDS)
Entity type:Individual
Prefix:DR
First Name:JOHN
Middle Name:WAI-LUN
Last Name:SUNG
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 1:22301 UNION TPKE
Mailing Address - Street 2:
Mailing Address - City:OAKLAND GARDENS
Mailing Address - State:NY
Mailing Address - Zip Code:11364-3644
Mailing Address - Country:US
Mailing Address - Phone:718-264-1188
Mailing Address - Fax:718-264-1180
Practice Address - Street 1:3625 UNION ST STE C
Practice Address - Street 2:
Practice Address - City:FLUSHING
Practice Address - State:NY
Practice Address - Zip Code:11354-4166
Practice Address - Country:US
Practice Address - Phone:718-539-5306
Practice Address - Fax:718-264-1180
Is Sole Proprietor?:No
Enumeration Date:2007-02-16
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY45033-011223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02227907Medicaid