Ji Moon Sur, DMD

Primary specialty

General Practice DentistryTaxonomy code 1223G0001X

License

DDS105329 Issued in CA

Practice address

5073 Piper Glen Ter
Dublin, CA 94568-7490

Phone

(215) 275-4585

NPI assigned

Mar 15, 2013

Last updated

Jan 18, 2024By the provider in NPPES

Sex

Female

Sole proprietor

Yes

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in CA

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: No
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

State licenses

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1363305600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1705536000000",
    "number": "1174864169",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6086 HILLBROOK PL",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945687316",
            "telephone_number": "215-275-4585"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5073 PIPER GLEN TER",
            "city": "DUBLIN",
            "state": "CA",
            "postal_code": "945687490",
            "telephone_number": "215-275-4585"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUR",
        "first_name": "JI MOON",
        "name_prefix": "Dr.",
        "credential": "DMD",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-03-15",
        "last_updated": "2024-01-18",
        "certification_date": "2024-01-18",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223G0001X",
            "taxonomy_group": "",
            "desc": "Dentist, General Practice",
            "state": "CA",
            "license": "DDS105329",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Karina Suarez
• Soujanya Sudanagunta, DDS
• Denny Sue
• Sharanya Sundaram
• Melissa R Sung, MD
• Sutter Bay Medical Foundation (Palo Alto Medical Foundation)
• Sutter Bay Medical Foundation (Palo Alto Medical Foundation)
• Taliah Suttles
• Jordanne Swafford
• Meghan Swanson

• General Practice Dentistry in Dublin, CA
• Providers in Dublin, CA by specialty
• General Practice Dentistry in California

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 18, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.