Provider Demographics
NPI:1225087836
Name:JENNIFER SUN, MD INC.
Entity Type:Organization
Organization Name:JENNIFER SUN, MD INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:CHIA JUNE
Authorized Official - Last Name:SUN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-392-3230
Mailing Address - Street 1:689 W FOOTHILL BLVD
Mailing Address - Street 2:SUITE B
Mailing Address - City:CLAREMONT
Mailing Address - State:CA
Mailing Address - Zip Code:91711-3400
Mailing Address - Country:US
Mailing Address - Phone:909-482-2058
Mailing Address - Fax:909-482-2092
Practice Address - Street 1:689 W FOOTHILL BLVD
Practice Address - Street 2:SUITE B
Practice Address - City:CLAREMONT
Practice Address - State:CA
Practice Address - Zip Code:91711-3400
Practice Address - Country:US
Practice Address - Phone:909-482-2058
Practice Address - Fax:909-482-2092
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-09
Last Update Date:2012-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA85118207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAI10911Medicare UPIN