Provider Demographics
NPI:1699325811
Name:SUNRISE DENTAL OF YAKIMA
Entity type:Organization
Organization Name:SUNRISE DENTAL OF YAKIMA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DENTIST
Authorized Official - Prefix:
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HSU
Authorized Official - Suffix:
Authorized Official - Credentials:DDS
Authorized Official - Phone:509-361-5599
Mailing Address - Street 1:1020 SOUTH 40TH AVENUE
Mailing Address - Street 2:SUITE G
Mailing Address - City:YAKIMA
Mailing Address - State:WA
Mailing Address - Zip Code:98908
Mailing Address - Country:US
Mailing Address - Phone:509-361-5599
Mailing Address - Fax:509-588-7086
Practice Address - Street 1:1020 SOUTH 40TH AVENUE
Practice Address - Street 2:SUITE G
Practice Address - City:YAKIMA
Practice Address - State:WA
Practice Address - Zip Code:98908
Practice Address - Country:US
Practice Address - Phone:509-361-5599
Practice Address - Fax:509-588-7086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-09-19
Last Update Date:2019-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty