Provider Demographics
NPI:1093291452
Name:SUN, SOPHIA WONG (OD)
Entity Type:Individual
Prefix:MRS
First Name:SOPHIA
Middle Name:WONG
Last Name:SUN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:MS
Other - First Name:SOPHIA
Other - Middle Name:
Other - Last Name:WONG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:OD
Mailing Address - Street 1:271 CLIFTON RD
Mailing Address - Street 2:
Mailing Address - City:PACIFICA
Mailing Address - State:CA
Mailing Address - Zip Code:94044
Mailing Address - Country:US
Mailing Address - Phone:415-810-9140
Mailing Address - Fax:
Practice Address - Street 1:2211 BUSH ST, 2ND FLOOR
Practice Address - Street 2:
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94115
Practice Address - Country:US
Practice Address - Phone:415-474-3333
Practice Address - Fax:415-474-3939
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-18
Last Update Date:2023-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA33991TLG152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist