MEDICARE: PAUL JIYOUNG SUNG DDS

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	1223P0700X	Prosthodontics	1002686-15	WI

General Provider Information

NPI Number	:	1205452224
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	PAUL JIYOUNG SUNG DDS

Provider Business Mailing Address
First Line	:	6121 7TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-4506
Country	:	US
Telephone Number	:	262-654-6535
Fax Number	:

Provider Business Practice Location Address
First Line	:	6121 7TH AVE
Second Line	:
City	:	KENOSHA
State	:	WI
Zip	:	53143-4506
Country	:	US
Telephone Number	:	262-654-6535
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/25/2020
Last Update Date	:	10/09/2025

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