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General NPI Number Information
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NPI Number | 1104697531
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Entity Type | Organization
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Legal Business Name | SUN SURGICAL DENTAL GROUP
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Dates
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Enumeration Date | 01/15/2024
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Last Update Date | 08/11/2025
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Provider Practice Location Address
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Address Line | 225 N JACKSON AVE
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City | SAN JOSE
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State | CA
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Zip | 95116-1603
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Country | US
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Telephone | 408-259-5000
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 2062
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City | DUBLIN
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State | CA
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Zip | 94568-0206
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CHIEF EXECUTIVE OFFICER
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Name | DR. HO HYUN BRIAN SUN
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Credential | DMD, MS
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Telephone | 408-413-2043
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 204E00000X
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Taxonomy Name | Oral & Maxillofacial Surgery (D.M.D.)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS0112X
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Taxonomy Name | Oral and Maxillofacial Surgery Clinic/Center
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number |
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License Number State |
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