Provider Demographics
NPI:1467676049
Name:SUN, JEN (MD)
Entity Type:Individual
Prefix:MR
First Name:JEN
Middle Name:
Last Name:SUN
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:210 N TUSTIN AVE
Mailing Address - Street 2:
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92705-3807
Mailing Address - Country:US
Mailing Address - Phone:800-883-7243
Mailing Address - Fax:714-647-1245
Practice Address - Street 1:8550 W CHARLESTON BLVD
Practice Address - Street 2:#102-136
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-9210
Practice Address - Country:US
Practice Address - Phone:206-948-2468
Practice Address - Fax:206-260-8833
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2011-08-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAA82642207L00000X
WAMD00041400207L00000X
WI46152020207L00000X
PAMD420604207L00000X
AZ31265207L00000X
IN01057989A207L00000X
GA60621207L00000X
IL36.120088207L00000X
MA234612207L00000X
MI4301091370207L00000X
MT11634207L00000X
NV12689207L00000X
NY247361207L00000X
ORMD28246207L00000X
WV23292207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAFB938AMedicare PIN