Healthcare Provider Details

I. General information

NPI: 1942318167
Provider Name (Legal Business Name): KUO TONG SUN DMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

Provider Other Name: KUO TONG SUN

II. Dates (important events)

Enumeration Date: 08/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2494 MISSION ST
SAN FRANCISCO CA
94110-2415
US

IV. Provider business mailing address

555 W BENJAMIN HOLT DR BUILDING B
STOCKTON CA
95207-3839
US

V. Phone/Fax

Practice location:
  • Phone: 415-821-1200
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223P0300X
TaxonomyPeriodontics
License Number36012
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: