Provider Demographics
NPI:1124147178
Name:WONG, SUNG-YU (DDS)
Entity type:Individual
Prefix:DR
First Name:SUNG-YU
Middle Name:
Last Name:WONG
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7853 ROESBORO CIR
Mailing Address - Street 2:
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95828-6937
Mailing Address - Country:US
Mailing Address - Phone:916-688-3679
Mailing Address - Fax:
Practice Address - Street 1:3945 MARYSVILLE BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95838-3711
Practice Address - Country:US
Practice Address - Phone:916-646-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-29
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA457911223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA45791OtherDENTAL LICENSE