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General NPI Number Information
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NPI Number | 1124514112
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Entity Type | Individual
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Provider Name | SEAN SUNYOTO DDS
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Gender | Male
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Dates
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Enumeration Date | 07/03/2018
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Last Update Date | 07/03/2018
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Provider Practice Location Address
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Address Line | 936 CRENSHAW BLVD STE 101
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City | LOS ANGELES
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State | CA
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Zip | 90019-1948
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Country | US
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Telephone | 323-934-2804
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Fax |
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Provider Business Mailing Address
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Address Line | 17840 POWELL PL
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City | ARTESIA
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State | CA
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Zip | 90701-3879
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Country | US
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Telephone | 626-510-2606
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 102689
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License Number State | CA
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