Active NPI
David T Sung, D.M.D.
- Dentist
- Goodyear, AZ
National Provider Identifier
1336453166
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Dentist
- License
- 8053
- Practice address
- 15530 W Roosevelt St
Goodyear, AZ 85338-6216 - Phone
- (623) 386-8333
- NPI assigned
- Aug 4, 2010
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Dentist | 122300000X | 8053 | AZ | Primary |
Addresses
Primary practice location
15530 W Roosevelt St
Goodyear, AZ 85338-6216
Mailing address
1125 E Princeton Ave
Gilbert, AZ 85234-3599
Phone (480) 205-8428
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in AZ
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: No
- Hospice: Yes
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20160322002820 | AZ | Order and Referring Only - Dentist | 2961709704 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 8053 | AZ | MD | Dentist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1280880000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1280880000000",
"number": "1336453166",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1125 E PRINCETON AVE",
"city": "GILBERT",
"state": "AZ",
"postal_code": "852343599",
"telephone_number": "480-205-8428"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "15530 W ROOSEVELT ST",
"city": "GOODYEAR",
"state": "AZ",
"postal_code": "853386216",
"telephone_number": "623-386-8333"
}
],
"practiceLocations": [],
"basic": {
"last_name": "SUNG",
"first_name": "DAVID",
"middle_name": "T",
"name_prefix": "Dr.",
"credential": "D.M.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2010-08-04",
"last_updated": "2010-08-04",
"status": "A"
},
"taxonomies": [
{
"code": "122300000X",
"taxonomy_group": "",
"desc": "Dentist",
"state": "AZ",
"license": "8053",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Goodyear, AZ
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 4, 2010; 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.