Provider Demographics
NPI:1063521722
Name:TIFFANIE J.SUN, D.D.S.PROFESSIONAL CORP
Entity type:Organization
Organization Name:TIFFANIE J.SUN, D.D.S.PROFESSIONAL CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:TIFFANIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:916-921-6051
Mailing Address - Street 1:1954 DEL PASO RD STE 142
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95834-7707
Mailing Address - Country:US
Mailing Address - Phone:916-921-6051
Mailing Address - Fax:916-921-6480
Practice Address - Street 1:1954 DEL PASO RD STE 142
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95834-7707
Practice Address - Country:US
Practice Address - Phone:916-921-6051
Practice Address - Fax:916-921-6480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-29
Last Update Date:2020-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA50681122300000X
CA47601122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty