Provider Demographics
NPI:1083136436
Name:SUN, YIFANG
Entity Type:Individual
Prefix:
First Name:YIFANG
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19328 GREENWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:CUPERTINO
Mailing Address - State:CA
Mailing Address - Zip Code:95014-3461
Mailing Address - Country:US
Mailing Address - Phone:408-761-1098
Mailing Address - Fax:
Practice Address - Street 1:3010 OLCOTT ST
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-3207
Practice Address - Country:US
Practice Address - Phone:408-731-8686
Practice Address - Fax:408-727-7020
Is Sole Proprietor?:Yes
Enumeration Date:2017-07-07
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPT12875225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPT12875OtherPHYSICAL THERAPY BOARD OF CALIFORNIA