MEDICARE: DR. JAY J SUNG DDS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1223E0200X	Endodontics	39093	CA

General Provider Information

NPI Number	:	1457554362
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JAY J SUNG DDS

Provider Business Mailing Address
First Line	:	174 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-915-5317
Fax Number	:	626-966-0244

Provider Business Practice Location Address
First Line	:	174 W COLLEGE ST
Second Line	:
City	:	COVINA
State	:	CA
Zip	:	91723-2007
Country	:	US
Telephone Number	:	626-915-5317
Fax Number	:	626-966-0244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/07/2007
Last Update Date	:	01/08/2015

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