Provider Demographics
NPI:1275163248
Name:SUN, QIAN
Entity Type:Individual
Prefix:
First Name:QIAN
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:737 SAINT JOHNS AVE
Mailing Address - Street 2:
Mailing Address - City:HIGHLAND PARK
Mailing Address - State:IL
Mailing Address - Zip Code:60035-4650
Mailing Address - Country:US
Mailing Address - Phone:847-805-8088
Mailing Address - Fax:847-805-8844
Practice Address - Street 1:737 SAINT JOHNS AVE
Practice Address - Street 2:
Practice Address - City:HIGHLAND PARK
Practice Address - State:IL
Practice Address - Zip Code:60035-4650
Practice Address - Country:US
Practice Address - Phone:847-805-8088
Practice Address - Fax:847-805-8844
Is Sole Proprietor?:No
Enumeration Date:2020-01-18
Last Update Date:2022-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL085.008121363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant