Provider Demographics
NPI:1225120132
Name:SUN, YUN-LAI (MD)
Entity Type:Individual
Prefix:DR
First Name:YUN-LAI
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 1:5295 OBERLIN AVE
Mailing Address - Street 2:
Mailing Address - City:LORAIN
Mailing Address - State:OH
Mailing Address - Zip Code:44053-3435
Mailing Address - Country:US
Mailing Address - Phone:440-282-7679
Mailing Address - Fax:440-282-5742
Practice Address - Street 1:5295 OBERLIN AVE
Practice Address - Street 2:
Practice Address - City:LORAIN
Practice Address - State:OH
Practice Address - Zip Code:44053-3435
Practice Address - Country:US
Practice Address - Phone:440-282-7679
Practice Address - Fax:440-282-5742
Is Sole Proprietor?:No
Enumeration Date:2006-09-28
Last Update Date:2012-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35040233208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472877Medicaid
OHSU0491247Medicare ID - Type Unspecified
OH0472877Medicaid