Provider Demographics
NPI:1073590907
Name:SUN, JIMMY JYH-MING (MD)
Entity Type:Individual
Prefix:
First Name:JIMMY
Middle Name:JYH-MING
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3660 ARLINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:RIVERSIDE
Mailing Address - State:CA
Mailing Address - Zip Code:92506-3912
Mailing Address - Country:US
Mailing Address - Phone:951-493-6920
Mailing Address - Fax:951-738-8813
Practice Address - Street 1:818 MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:CORONA
Practice Address - State:CA
Practice Address - Zip Code:92879-3128
Practice Address - Country:US
Practice Address - Phone:951-493-6920
Practice Address - Fax:951-738-8813
Is Sole Proprietor?:No
Enumeration Date:2005-12-30
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA72737207Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Y00000XAllopathic & Osteopathic PhysiciansOtolaryngology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ31887ZOtherSITE PTAN
00A727370Medicare ID - Type Unspecified
CAZZZ31887ZOtherSITE PTAN