MEDICARE: DR. JESSAMINE SUNGLAO D.D.S.

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	1223G0001X	General Practice Dentistry	46981	CA

General Provider Information

NPI Number	:	1891909081
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. JESSAMINE SUNGLAO D.D.S.

Provider Business Mailing Address
First Line	:	3903 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2614
Country	:	US
Telephone Number	:	562-427-2478
Fax Number	:	562-981-9258

Provider Business Practice Location Address
First Line	:	3903 LONG BEACH BLVD
Second Line	:
City	:	LONG BEACH
State	:	CA
Zip	:	90807-2614
Country	:	US
Telephone Number	:	562-427-2478
Fax Number	:	562-981-9258

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

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	02/24/2010

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