Provider Demographics
NPI:1720130834
Name:WEE, SUNGCHUN STEVEN (DDS)
Entity type:Individual
Prefix:
First Name:SUNGCHUN
Middle Name:STEVEN
Last Name:WEE
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 1:71757 29 PALMS HWY STE C
Mailing Address - Street 2:
Mailing Address - City:TWENTYNINE PALMS
Mailing Address - State:CA
Mailing Address - Zip Code:92277-2085
Mailing Address - Country:US
Mailing Address - Phone:760-367-1100
Mailing Address - Fax:760-367-2033
Practice Address - Street 1:71757 29 PALMS HWY STE C
Practice Address - Street 2:
Practice Address - City:TWENTYNINE PALMS
Practice Address - State:CA
Practice Address - Zip Code:92277-2085
Practice Address - Country:US
Practice Address - Phone:760-367-1100
Practice Address - Fax:760-367-2033
Is Sole Proprietor?:No
Enumeration Date:2007-01-17
Last Update Date:2016-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA473351223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA245907OtherTRIGON
CA857275OtherUNITED CONCORDIA
CAG92915-01Medicaid
CA47335OtherALL OTHER INSURANCES