Provider Demographics
NPI:1215122205
Name:SUNG, KYUNG EUN (DDS)
Entity type:Individual
Prefix:DR
First Name:KYUNG
Middle Name:EUN
Last Name:SUNG
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 SOMERSET LN APT 106
Mailing Address - Street 2:
Mailing Address - City:EDGEWATER
Mailing Address - State:NJ
Mailing Address - Zip Code:07020-2414
Mailing Address - Country:US
Mailing Address - Phone:201-424-9338
Mailing Address - Fax:
Practice Address - Street 1:1088 CENTRAL PARK AVE
Practice Address - Street 2:
Practice Address - City:SCARSDALE
Practice Address - State:NY
Practice Address - Zip Code:10583-3234
Practice Address - Country:US
Practice Address - Phone:914-861-4777
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-12
Last Update Date:2020-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY053404-1122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY02877627Medicaid