Provider Demographics
NPI:1881115178
Name:SUN, KEJIA JULIA (DMD)
Entity type:Individual
Prefix:
First Name:KEJIA
Middle Name:JULIA
Last Name:SUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1613 SHADY OAKS DR
Mailing Address - Street 2:
Mailing Address - City:OLDSMAR
Mailing Address - State:FL
Mailing Address - Zip Code:34677-2776
Mailing Address - Country:US
Mailing Address - Phone:813-451-2828
Mailing Address - Fax:
Practice Address - Street 1:5122 DR PHILLIPS BLVD
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32819-3312
Practice Address - Country:US
Practice Address - Phone:407-434-8344
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-28
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLDN225941223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice