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General NPI Number Information
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NPI Number | 1730635111
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Entity Type | Individual
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Provider Name | JINYU SUN D.D.S
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Gender | Male
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Dates
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Enumeration Date | 08/26/2016
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Last Update Date | 08/26/2016
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Provider Practice Location Address
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Address Line | 13232 HUNT RDG
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City | ELLICOTT CITY
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State | MD
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Zip | 21042-1153
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Country | US
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Telephone | 410-491-8686
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Fax |
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Provider Business Mailing Address
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Address Line | 610 PROFESSIONAL DR SUITE 215
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City | GAITHERSBURG
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State | MD
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Zip | 20879-3413
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Country | US
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Telephone | 301-869-8666
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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 | 16144
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License Number State | MD
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