Provider Demographics
NPI:1588091763
Name:SUN, HEEJOON YU (DMD, MPH)
Entity type:Individual
Prefix:DR
First Name:HEEJOON
Middle Name:YU
Last Name:SUN
Suffix:
Gender:F
Credentials:DMD, MPH
Other - Prefix:DR
Other - First Name:JOON
Other - Middle Name:YU
Other - Last Name:SUN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DMD, MPH
Mailing Address - Street 1:1315 MACOM DR STE 201
Mailing Address - Street 2:
Mailing Address - City:NAPERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60564-9361
Mailing Address - Country:US
Mailing Address - Phone:630-978-9005
Mailing Address - Fax:630-978-9145
Practice Address - Street 1:1315 MACOM DR STE 201
Practice Address - Street 2:
Practice Address - City:NAPERVILLE
Practice Address - State:IL
Practice Address - Zip Code:60564-9361
Practice Address - Country:US
Practice Address - Phone:630-978-9005
Practice Address - Fax:630-978-9145
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-02
Last Update Date:2013-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL019-022278122300000X, 1223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No122300000XDental ProvidersDentist
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILNPI # 1407916737OtherBUSINESS NPI # 1407916737