=====================================================
General NPI Number Information
=====================================================
NPI Number | 1225109754
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SUN DENTAL ASSOCIATES PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/13/2006
-----------------------------------------------------
Last Update Date | 07/23/2013
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9087 SHADY GROVE COURT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-921-6338
-----------------------------------------------------
Fax | 301-605-7353
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9087 SHADY GROVE COURT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-921-6338
-----------------------------------------------------
Fax | 301-605-7353
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | DOCTOR OF DENTAL SURGERY PRESIDENT
-----------------------------------------------------
Name | DR. RICHARD YUANG-PAY SUN
-----------------------------------------------------
Credential | DDS
-----------------------------------------------------
Telephone | 301-921-6338
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 122300000X
-----------------------------------------------------
Taxonomy Name | Dentist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------