Provider Demographics
NPI:1043586381
Name:SY, MARILYN H (DDS)
Entity type:Individual
Prefix:
First Name:MARILYN
Middle Name:H
Last Name:SY
Suffix:
Gender:F
Credentials:DDS
Other - Prefix:
Other - First Name:MARILYN
Other - Middle Name:HU SY
Other - Last Name:CHONG
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DDS
Mailing Address - Street 1:1133 EL CAMINO REAL
Mailing Address - Street 2:SUITE 5
Mailing Address - City:SOUTH SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94080-3288
Mailing Address - Country:US
Mailing Address - Phone:650-588-8848
Mailing Address - Fax:650-244-9284
Practice Address - Street 1:1133 EL CAMINO REAL
Practice Address - Street 2:SUITE 5
Practice Address - City:SOUTH SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94080-3288
Practice Address - Country:US
Practice Address - Phone:650-588-8848
Practice Address - Fax:650-244-9284
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-30
Last Update Date:2012-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA29184122300000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes122300000XDental ProvidersDentist