Healthcare Provider Details

I. General information

NPI: 1770491649
Provider Name (Legal Business Name): SUJIN SIN DDS
Entity Type: Individual
Gender:
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/31/2026
Last Update Date: 08/31/2026
Certification Date: 08/31/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27830 GREENSPOT RD STE 3
HIGHLAND CA
92346-4451
US

IV. Provider business mailing address

27830 GREENSPOT RD STE 3
HIGHLAND CA
92346-4451
US

V. Phone/Fax

Practice location:
  • Phone: 469-888-9044
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number113504
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: