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General NPI Number Information
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NPI Number | 1881115178
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Entity Type | Individual
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Provider Name | KEJIA JULIA SUN DMD
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Gender | Female
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Dates
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Enumeration Date | 06/28/2017
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Last Update Date | 03/17/2018
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Provider Practice Location Address
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Address Line | 5122 DR PHILLIPS BLVD
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City | ORLANDO
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State | FL
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Zip | 32819-3312
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Country | US
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Telephone | 407-434-8344
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Fax |
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Provider Business Mailing Address
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Address Line | 1613 SHADY OAKS DR
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City | OLDSMAR
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State | FL
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Zip | 34677-2776
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Country | US
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Telephone | 813-451-2828
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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 | 1223G0001X
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Taxonomy Name | General Practice Dentistry
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License Number | DN22594
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License Number State | FL
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