Healthcare Provider Details

I. General information

NPI: 1376120592
Provider Name (Legal Business Name): SUNG SHYN, DDS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/24/2021
Last Update Date: 03/25/2021
Certification Date: 03/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

240 W SHAW AVE STE 110
CLOVIS CA
93612-3694
US

IV. Provider business mailing address

240 W SHAW AVE STE 110
CLOVIS CA
93612-3694
US

V. Phone/Fax

Practice location:
  • Phone: 559-325-8000
  • Fax: 559-325-6989
Mailing address:
  • Phone: 559-325-8000
  • Fax: 559-325-6989

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number
License Number State

VIII. Authorized Official

Name: DR. SUNG SHYN
Title or Position: PRESIDENT
Credential: DDS
Phone: 559-325-8000