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General NPI Number Information
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NPI Number | 1376767475
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Entity Type | Individual
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Provider Name | SARAH SOHYUN BONG-THAKUR DDS
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 1005 W 120TH AVE STE 800
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City | WESTMINSTER
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State | CO
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Zip | 80234-2747
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Country | US
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Telephone | 720-263-5420
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Fax |
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Provider Business Mailing Address
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Address Line | 1005 W 120TH AVE STE 800
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City | WESTMINSTER
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State | CO
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Zip | 80234-2747
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Country | US
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Telephone | 720-263-5420
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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 | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 0401411892
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License Number State | VA
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Taxonomy #2
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Taxonomy Code | 1223S0112X
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Taxonomy Name | Oral and Maxillofacial Surgery (Dentist)
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License Number | 00203802
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License Number State | CO
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