Provider Demographics
NPI:1376871723
Name:SUN, PENG (LIC AC)
Entity Type:Individual
Prefix:DR
First Name:PENG
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:LIC AC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 W MARLETTE AVE
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85015-2039
Mailing Address - Country:US
Mailing Address - Phone:623-552-0944
Mailing Address - Fax:
Practice Address - Street 1:1845 W MARLETTE AVE
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85015-2039
Practice Address - Country:US
Practice Address - Phone:623-552-0944
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-11-23
Last Update Date:2012-10-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ0844171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist