Provider Demographics
NPI:1437569456
Name:SUN, WENHUI (DMD)
Entity type:Individual
Prefix:
First Name:WENHUI
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2606 STEWART AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:WAUSAU
Mailing Address - State:WI
Mailing Address - Zip Code:54401-5450
Mailing Address - Country:US
Mailing Address - Phone:715-842-5691
Mailing Address - Fax:
Practice Address - Street 1:75 ARCH ST STE 303
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44304-1432
Practice Address - Country:US
Practice Address - Phone:330-375-6262
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2024-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH390200000X
WI1001740-151223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH39(STUDENTHEALTHCAREMedicaid