Healthcare Provider Details

I. General information

NPI: 1255343075
Provider Name (Legal Business Name): SUN-YUNG BAK D.D.S.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/12/2006
Last Update Date: 09/30/2021
Certification Date: 09/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1011 N UNIVERSITY AVE
ANN ARBOR MI
48109-1078
US

IV. Provider business mailing address

1011 N UNIVERSITY AVE RM K1018
ANN ARBOR MI
48109-1078
US

V. Phone/Fax

Practice location:
  • Phone: 734-764-5527
  • Fax:
Mailing address:
  • Phone: 734-764-5527
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code122300000X
TaxonomyDentist
License Number00132
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code1223G0001X
TaxonomyGeneral Practice Dentistry
License Number047799
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code1223P0700X
TaxonomyProsthodontics
License Number2901022863
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: