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NPI Code Detail

MEDICARE: DR. SUN-YUNG BAK D.D.S.

MEDICARE: DR. SUN-YUNG BAK D.D.S.
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
1122300000XDentist00132NC
21223G0001XGeneral Practice Dentistry047799NY
31223P0700XProsthodontics2901022863MI

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
100132OTHERNCNC STATE BOARD OF DENTAL EXAMINERS
2047799OTHERNYNY LICENSE

General Provider Information

NPI Number : 1255343075
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. SUN-YUNG BAK D.D.S.
Provider Business Mailing Address
First Line : 1011 N UNIVERSITY AVE RM K1018
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-1078
Country : US
Telephone Number : 734-764-5527
Fax Number :
Provider Business Practice Location Address
First Line : 1011 N UNIVERSITY AVE
Second Line :
City : ANN ARBOR
State : MI
Zip : 48109-1078
Country : US
Telephone Number : 734-764-5527
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/12/2006
Last Update Date : 09/30/2021

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