Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 00132 | NC |
N | 1223G0001X | General Practice | 047799 | NY |
N | 213EG0000X | General Practice | 047799 | NY |
Y | 1223P0700X | Prosthodontist | 2901022863 | MI |
NPI | 1255343075 |
---|---|
Provider Name | Dr. Sun-Yung Bak |
First Address | Ann Arbor, MI 48109-1078 |
Second Address | Ann Arbor, MI 48109-1078 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 12/08/2006 |
Last Update Date | 30/09/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
00132 | NC STATE BOARD OF DENTAL EXAMINERS (01) | NC |
047799 | NY LICENSE (01) | NY |