Provider Demographics
NPI:1104037043
Name:SUN, WENSI (MD, PHD)
Entity Type:Individual
Prefix:DR
First Name:WENSI
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11231 ROOSEVELT WAY NE
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98125-6225
Mailing Address - Country:US
Mailing Address - Phone:206-365-5800
Mailing Address - Fax:206-364-2072
Practice Address - Street 1:11231 ROOSEVELT WAY, NE
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98125
Practice Address - Country:US
Practice Address - Phone:206-365-5800
Practice Address - Fax:206-364-2072
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2014-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMD00039922207W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207W00000XAllopathic & Osteopathic PhysiciansOphthalmology
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA8277964Medicaid
WAG8852976Medicare PIN
WA8277964Medicaid