Healthcare Provider Details

I. General information

NPI: 1649623331
Provider Name (Legal Business Name): SOOKYUNG JUN DMD PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2016
Last Update Date: 07/18/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 145TH PL SE
BELLEVUE WA
98007-5516
US

IV. Provider business mailing address

1500 145TH PL SE
BELLEVUE WA
98007-5516
US

V. Phone/Fax

Practice location:
  • Phone: 425-321-0833
  • Fax:
Mailing address:
  • Phone: 425-321-0833
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number60421965
License Number StateWA

VIII. Authorized Official

Name: SOOKYUNG JUN
Title or Position: OWNER DENTIST
Credential: DMD
Phone: 425-321-0833