Physician Compare National (NPI:1124514112)

HEALTHCARE PROVIDER: SEAN SUNYOTO DDS

Physician Compare National contains general information about individual eligible professionals (EPs) such as demographic information and Medicare quality program participation.

Individual Professional Information
NPI	1124514112
	Unique healthcare provider (clinician) ID assigned by NPPES
PECOS UID	0749515674
	Unique individual clinician ID assigned by PECOS
Professional Enrollment ID	I20190715000865
	Unique ID for the individual professional enrollment that is the source for the data in the observation
Provider Last Name	SUNYOTO
	Individual professional last name
Provider First Name	SEAN
	Individual professional first name
Provider Gender	M
	The provider's gender if the provider is a person.

Medical School Information
Medical School Name	UNIV OF THE PACIFIC DUGONI SCHOOL OF DENTISTRY
	Individual professional's medical school
Graduation Year	2018
	Individual professional's medical school graduation year
Primary Specialty	ORAL SURGERY
	Primary medical specialty reported by the individual professional in the selected enrollment
Secondary Specialty 1	DENTIST
	First secondary medical specialty reported by the individual professional in the selected enrollment
All Secondary Specialties	DENTIST
	All four secondary specialties reported by the individual professional in the selected enrollment, separated by commas

Practice Information
Organization Legal Name	SEAN KIM DDS INC
	Legal name of the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Group Practice PAC ID	9830424761
	Unique Group Practice ID assigned by PECOS to the Group Practice that the individual professional works with- will be blank if the address is not linked to a Group Practice
Number of Group Practice members	2
	Total number of individual professionals affiliated with the Group Practice based on Group Practice PAC ID
Line 1 Street Address	1213 N LAKE AVE
	Group Practice or individual's line 1 address
Line 2 Street Address	SUITE 1
	Group Practice or individual's line 2 address
City	PASADENA
	Group Practice or individual's city
State	CA
	Group Practice or individual's state
Zip Code	911043768
	Group Practice or individual's zip code (9 digits when available)
Phone Number	6265841800
	Phone number is listed only when there is a single phone number available for the practice location address

Hospital(s) Affiliation Information
Professional Accepts Medicare Assignment	Y