Provider Demographics
NPI:1124037221
Name:SUN, TOMMY (MD)
Entity Type:Individual
Prefix:DR
First Name:TOMMY
Middle Name:
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 1:3396 HOLLAND RD
Mailing Address - Street 2:#105
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23452-4824
Mailing Address - Country:US
Mailing Address - Phone:757-427-9194
Mailing Address - Fax:
Practice Address - Street 1:3396 HOLLAND RD
Practice Address - Street 2:#105
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23452-4824
Practice Address - Country:US
Practice Address - Phone:757-427-9194
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-07
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0101032911207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA5616697Medicaid
VA5616697Medicaid
VA080000211Medicare PIN