Provider Demographics
NPI:1104104108
Name:SUNSET DENTAL PROFESSIONALS
Entity type:Organization
Organization Name:SUNSET DENTAL PROFESSIONALS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ANDREW
Authorized Official - Middle Name:WOOSUNG
Authorized Official - Last Name:KNON
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:626-960-2766
Mailing Address - Street 1:1042 W WEST COVINA PARKWAY
Mailing Address - Street 2:
Mailing Address - City:WEST COVINA
Mailing Address - State:CA
Mailing Address - Zip Code:91790
Mailing Address - Country:US
Mailing Address - Phone:626-960-2766
Mailing Address - Fax:626-962-8216
Practice Address - Street 1:142 W WEST COVINA PARKWAY
Practice Address - Street 2:
Practice Address - City:WEST COVINA
Practice Address - State:CA
Practice Address - Zip Code:91790
Practice Address - Country:US
Practice Address - Phone:626-960-2766
Practice Address - Fax:626-962-8216
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-26
Last Update Date:2011-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA54659122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes122300000XDental ProvidersDentistGroup - Single Specialty