Healthcare Provider Details

I. General information

NPI: 1053224980
Provider Name (Legal Business Name): JIABAO SUN, D.M.D., M.D.S., LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2026
Last Update Date: 09/23/2026
Certification Date: 09/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9774 CINCINNATI COLUMBUS RD STE G
WEST CHESTER OH
45241-1073
US

IV. Provider business mailing address

9774 CINCINNATI COLUMBUS RD STE G
WEST CHESTER OH
45241-1073
US

V. Phone/Fax

Practice location:
  • Phone: --
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JIABAO SUN
Title or Position: MEMBER
Credential: DMD, MDS
Phone: 216-556-3057