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General NPI Number Information
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NPI Number | 1285296095
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Entity Type | Individual
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Provider Name | KATHLEEN JING SUN DDS
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Gender | Female
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Dates
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Enumeration Date | 07/01/2019
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Last Update Date | 06/06/2024
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Provider Practice Location Address
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Address Line | 1659 N CLYDE MORRIS BLVD
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City | DAYTONA BEACH
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State | FL
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Zip | 32117
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Country | US
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Telephone | 386-274-1450
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Fax |
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Provider Business Mailing Address
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Address Line | 1227 N ATLANTIC AVE
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City | NEW SMYRNA BEACH
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State | FL
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Zip | 32169-2203
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Country | US
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Telephone | 713-423-9442
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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 | 35286
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN28754
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License Number State | FL
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