Provider Demographics
NPI:1396142154
Name:HUR, GRACE SUN AE (DDS)
Entity type:Individual
Prefix:
First Name:GRACE SUN AE
Middle Name:
Last Name:HUR
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 1:770 THE CITY DR S STE 8450
Mailing Address - Street 2:
Mailing Address - City:ORANGE
Mailing Address - State:CA
Mailing Address - Zip Code:92868-4970
Mailing Address - Country:US
Mailing Address - Phone:646-221-1217
Mailing Address - Fax:
Practice Address - Street 1:2551 W BALL RD
Practice Address - Street 2:
Practice Address - City:ANAHEIM
Practice Address - State:CA
Practice Address - Zip Code:92804-4001
Practice Address - Country:US
Practice Address - Phone:646-221-1217
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-21
Last Update Date:2022-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ22DI025772001223X0400X
CA1031871223X0400X
NY0579151223X0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223X0400XDental ProvidersDentistOrthodontics and Dentofacial Orthopedics