Healthcare Provider Details

I. General information

NPI: 1750610390
Provider Name (Legal Business Name): SI YEUN SUNG DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/10/2009
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1032 E 6TH ST
CORONA CA
92879-1613
US

IV. Provider business mailing address

1032 E 6TH ST
CORONA CA
92879-1613
US

V. Phone/Fax

Practice location:
  • Phone: 951-520-8221
  • Fax:
Mailing address:
  • Phone: 951-520-8221
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number58583
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: