Provider Demographics
NPI:1326394115
Name:SUN, JIERU (LAC)
Entity Type:Individual
Prefix:
First Name:JIERU
Middle Name:
Last Name:SUN
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:252 BRIDGE ST BLDG G
Mailing Address - Street 2:
Mailing Address - City:METUCHEN
Mailing Address - State:NJ
Mailing Address - Zip Code:08840-2294
Mailing Address - Country:US
Mailing Address - Phone:646-705-7868
Mailing Address - Fax:
Practice Address - Street 1:252 BRIDGE ST BLDG G
Practice Address - Street 2:
Practice Address - City:METUCHEN
Practice Address - State:NJ
Practice Address - Zip Code:08840-2294
Practice Address - Country:US
Practice Address - Phone:646-705-7868
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-30
Last Update Date:2020-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY004851171100000X
NJ25MZ00093800171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist