Provider Demographics
NPI:1225171754
Name:SUN, PEI FANG (MD)
Entity Type:Individual
Prefix:DR
First Name:PEI
Middle Name:FANG
Last Name:SUN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Mailing Address - Street 1:850 N MAIN STREET EXT
Mailing Address - Street 2:BUILDING1,A3
Mailing Address - City:WALLINGFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06492-2400
Mailing Address - Country:US
Mailing Address - Phone:203-269-4353
Mailing Address - Fax:203-269-4606
Practice Address - Street 1:850 N MAIN STREET EXT
Practice Address - Street 2:BUILDING1,A3
Practice Address - City:WALLINGFORD
Practice Address - State:CT
Practice Address - Zip Code:06492-2400
Practice Address - Country:US
Practice Address - Phone:203-269-4353
Practice Address - Fax:203-269-4606
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-15
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT037546207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT110007806Medicare PIN
CTG97973Medicare UPIN