Provider Demographics
NPI:1881087740
Name:JEOUN, SUNGMIN PETER (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNGMIN
Middle Name:PETER
Last Name:JEOUN
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 1:616 VIRGINIA BEACH BLVD
Mailing Address - Street 2:#102
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23451-4274
Mailing Address - Country:US
Mailing Address - Phone:757-769-7155
Mailing Address - Fax:
Practice Address - Street 1:616 VIRGINIA BEACH BLVD
Practice Address - Street 2:#102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23451-4274
Practice Address - Country:US
Practice Address - Phone:757-769-7155
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-16
Last Update Date:2017-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA04014149491223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice