Jiabao Sun, DMD, MDS

Primary specialty

Orthodontics and Dentofacial Orthopedics DentistryTaxonomy code 1223X0400X

License

30026186 Issued in OH

Practice address

5964 S State Route 48
Maineville, OH 45039-8845

Phone

(513) 239-8104

NPI assigned

Jan 17, 2024

Last updated

Feb 10, 2024By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Shine Orthodontics

  • Dental Clinic/Center
  • Chillicothe, OH
  • NPI 1336603653
  NPD (past)

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

{
    "created_epoch": "1705449600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1707523200000",
    "number": "1811758824",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3718 NANTUCKET DR",
            "city": "LOVELAND",
            "state": "OH",
            "postal_code": "451403612"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5964 S STATE ROUTE 48",
            "city": "MAINEVILLE",
            "state": "OH",
            "postal_code": "450398845",
            "telephone_number": "513-239-8104"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SUN",
        "first_name": "JIABAO",
        "name_prefix": "Dr.",
        "credential": "DMD, MDS",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2024-01-17",
        "last_updated": "2024-02-10",
        "certification_date": "2024-02-10",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "OH",
            "license": "30026186",
            "primary": true
        },
        {
            "code": "1223X0400X",
            "taxonomy_group": "",
            "desc": "Dentist, Orthodontics and Dentofacial Orthopedics",
            "state": "PA",
            "license": "220543813",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Shelley A Stanforth, MD
• Rhonda Stegemoller, PTA
• Katelyn Renee Stegmann
• Lori Green Stotz, MD
• Katherine J. Suez, RN
• Daniel L Swagerty Jr., M.D.
• Caden Swanson
• Tate and Uhl Vip Medical Transportation LLC (VIP Medical Transportation LLC)
• Michelle Tatman, RD
• The Colorful Spot Pediatric Therapy LLC

• Orthodontics and Dentofacial Orthopedics Dentistry in Maineville, OH
• Providers in Maineville, OH by specialty
• Orthodontics and Dentofacial Orthopedics Dentistry in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 10, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.