Provider Demographics
NPI:1154556462
Name:SUNG, WON (DDS)
Entity type:Individual
Prefix:
First Name:WON
Middle Name:
Last Name:SUNG
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 1:431 SUMMIT ST
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3861
Mailing Address - Country:US
Mailing Address - Phone:213-249-1765
Mailing Address - Fax:
Practice Address - Street 1:431 SUMMIT ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-3861
Practice Address - Country:US
Practice Address - Phone:213-249-1765
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-05-16
Last Update Date:2022-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019.027933122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist