MEDICARE: DENTAL SUNSHINE

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	122300000X	Dentist	019026407	IL

General Provider Information

NPI Number	:	1083868525
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DENTAL SUNSHINE

Provider Business Mailing Address
First Line	:	1803 S THROOP STREET
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60608
Country	:	US
Telephone Number	:	312-633-0400
Fax Number	:

Provider Business Practice Location Address
First Line	:	233 E 13TH ST
Second Line	:	1309
City	:	CHICAGO
State	:	IL
Zip	:	60605
Country	:	US
Telephone Number	:	312-633-0400
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	HYUN SUN CHUN
Credential	:
Telephone Number	:	312-633-0400

Provider Enumeration Date	:	11/11/2008
Last Update Date	:	11/11/2008

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Directions to “DENTAL SUNSHINE ” Practice Location

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