Healthcare Provider Details

I. General information

NPI: 1740472950
Provider Name (Legal Business Name): SUNG SOO SHYN DDS
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/11/2007
Last Update Date: 03/24/2021
Certification Date: 03/24/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

355 MONTE VISTA DR STE D
DINUBA CA
93618-9229
US

IV. Provider business mailing address

PO BOX 27425
FRESNO CA
93729-7425
US

V. Phone/Fax

Practice location:
  • Phone: 559-596-0300
  • Fax:
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 NumberDDS50862
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: