Healthcare Provider Details

I. General information

NPI: 1679678585
Provider Name (Legal Business Name): SUNNY YOUNG HUTCHINSON DDS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2410 SYCAMORE DR STE. A
SIMI VALLEY CA
93065-2350
US

IV. Provider business mailing address

2860 MICHELLE 2ND FLOOR
IRVINE CA
92606-1009
US

V. Phone/Fax

Practice location:
  • Phone: 805-522-2600
  • Fax: 805-522-2683
Mailing address:
  • Phone: 714-508-3600
  • Fax: 714-368-2092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1223X0400X
TaxonomyOrthodontics and Dentofacial Orthopedics Dentistry
License Number49761
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: