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General NPI Number Information
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NPI Number | 1609208040
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Entity Type | Individual
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Provider Name | SUNG YEON JI DDS
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Gender | Female
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Dates
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Enumeration Date | 08/08/2013
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Last Update Date | 09/22/2015
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Provider Practice Location Address
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Address Line | 927 COUNTRY CLUB RD STE 100
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City | EUGENE
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State | OR
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Zip | 97401-6018
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Country | US
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Telephone | 458-201-8471
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Fax |
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Provider Business Mailing Address
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Address Line | 13190 SE 162ND AVE APT 219
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City | HAPPY VALLEY
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State | OR
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Zip | 97015-3780
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Country | US
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Telephone | 971-266-7043
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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 | 019029604
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License Number State | IL
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Taxonomy #2
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | D10100
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License Number State | OR
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