Healthcare Provider Details

I. General information

NPI: 1932537131
Provider Name (Legal Business Name): JENNY SUN D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2013
Last Update Date: 04/28/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3425 W THUNDERBIRD RD SUITE 1
PHOENIX AZ
85053-5670
US

IV. Provider business mailing address

231 HARRISON AVE APT 11
BOSTON MA
02111-1857
US

V. Phone/Fax

Practice location:
  • Phone: 480-363-7952
  • Fax:
Mailing address:
  • Phone: 480-363-7952
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number9167
License Number StateAZ
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: